Evidence of Lumbar Multifidus Muscle Wasting Ipsilateral to Symptoms in Patients with Acute/Subacute Low Back Pain

Hides, Julie; Stokes, María; Saide, M; Jull, Gwendolen; Cooper, D. H.

doi:10.1097/00007632-199401001-00009

Cited by 817 publications

(602 citation statements)

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“…Although we were only able to identify a significant relationship between multifidus density and spondylolisthesis when we used the summative measure from the principle component analysis, when data were considered separately for each level we identified an association between muscle density of multifidus and/or erector spinae at a specific lumbar level and FJOA, disc narrowing, and spondylolisthesis and related levels. This is consistent with data of Hides [16], and Hodges [17] following acute pain/ injury and Danneels [6] in chronic LBP, L4 multifidus density was reduced in association with FJOA or spondylolisthesis at L4-5. As multifidus fibers arising from L4 arise from the caudal border of the spinous process and adjacent lamina [38], their bulk lies adjacent to L5.…”

Section: Discussionsupporting

confidence: 92%

“…However, this could be related to our criteria for back pain, or because our measure combined data across levels, which may have reduced the sensitivity. This is important to consider as several earlier studies have identified changes only at specific levels of the spine [6,16]. In this study, we could not investigate changes specifically associated with the level of pain as it was not possible to determine which was the symptomatic level(s) in this population.…”

Section: Discussionmentioning

confidence: 94%

“…Danneels et al [6] found the atrophy was selective for multifidus, as neither the psoas nor erector spinae muscle masses were significantly smaller compared with matched controls. Hides et al [16] found marked wasting of multifidus on the symptomatic side, isolated to one vertebral level in patients with acute LBP. They proposed that the wasting was not likely to be due to disuse atrophy because of the rapidity of onset and localized distribution.…”

Section: Discussionmentioning

confidence: 98%

“…There is a growing body of evidence for association between paraspinal muscles degeneration and LBP. In several imaging studies, LBP has been investigated in relation to paraspinal muscle CSA [1,6,12,14,16,28,41,47,48,52], MRI signal intensity [10], and fat infiltration [1,6,12,14,19,21,23,28,32,41,47,52]. In patients with chronic LBP, studies consistently show a decrease in CSA [6,12,23], which may reach 10% compared to healthy individuals [19].…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence suggests that the paraspinal muscles are smaller in patients with chronic LBP [4,6,40,50] than in healthy individuals of similar age. Reduced size of multifidus has also been reported in acute LBP [16] and recent animal work has shown rapid changes in CSA in the multifidus muscle following discrete injury to an intervertebral disc [17]. In several imaging studies, chronic LBP was found to be associated with CT-evaluated muscle density (measured in Hounsfield units) [14,19,28].…”

Section: Introductionmentioning

confidence: 88%

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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

et al. 2009

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The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

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