Low Back Pain in Patients with Lumbar Spinal Stenosis-Hemodynamic and electrophysiological study of the lumbar multifidus muscles

Abstract

Abstract:Introduction: Several studies have demonstrated improvement in low back pain (LBP) after decompression surgery for lower extremity symptoms in lumbar spinal stenosis (LSS); however, the influence of neuropathic disorders on LBP is uncertain. Aim of this study is to identify the features of motion-induced and walking-induced LBP in patients with LSS and to assess whether neuropathic LBP develops.Methods: In total, 234 patients with LSS including L4/5 lesion were asked to identify their LBP. Subjects were classified into three groups: walking-induced LBP that aggravated during walking (W group), motion-induced LBP that aggravated during sitting up (M group), and no LBP (N group). Cross-sectional areas of the dural sac, lumbar multifidus, and the erector spinae were measured. Intramuscular oxygenation was evaluated with near-infrared spectrophotometer. Surface electromyography (EMG) and mechanomyography (MMG) were performed on the lumbar multifidus. Morphological, hemodynamic, and electrophysiological differences in the onset of LBP were evaluated.Results: The prevalence of W, M, and control groups was 31.2%, 32.1%, 36.8%, respectively. Concordance between the laterality of LBP and leg symptoms including pain and numbness was 86.3% in the W group and 47.0% in the M group. Dural sac area was lower in the W group than in the M and control groups. In the hemodynamic evaluation, the oxygenated hemoglobin level was significantly lower in the W group than in the M and N groups. In electrophysiological evaluation of lumbar multifidus, the mean power frequency in EMG was significantly higher in the W group than in the N group. Amplitude in MMG was significantly lower in the W group than in the N group.Conclusions: Neurologic disturbance in patients with LSS may be attributed to "neuropathic LBP." Neuropathic multifidus disorder plays a role in walking-induced LBP.

Radiological Assessment of Damage to the Iliopsoas Muscle by the Oblique Lateral Interbody Fusion Approach

“…For instance, the conventional posterior lumbar interbody fusion procedure caused more multifidus degeneration and postoperative low back pain than minimally invasive procedures such as percutaneous pedicle screw fixation 5,6 . These studies imply that dysfunction of the multifidus caused by surgical invasion is associated with low back pain 7 . However, few reports have evaluated the association between the clinical symptoms and changes in the physical properties of the psoas major after OLIF.…”

NIRS-EMG for Clinical Applications: A Systematic Review

“…It was shown that the subcutaneous tissue thickness over the lumbar paraspinal muscles strongly influenced the NIRS and EMG amplitude measurements; for this reason, it should be incorporated in the statistical analysis as confounding factor. More recently, in 2017, Sakai et al investigated patients with LBP (n = 273), after a decompression surgery, for lower extremity symptoms in lumbar spinal stenosis (LSS) [68]. The patients were, then, divided into three groups: Walking-induced, LBP that was aggravated during walking (W group); motion-induced, LBP that was aggravated during sitting (M group); and no LBP (N group).…”

Effects of Different Seat Pressures and Rowing Cadences on Muscle Oxygenation and Physiological Parameter Responses

“…Studies have demonstrated that fatigue occurs later when the body maintains a higher muscle tissue oxygenation concentration [11]. In certain studies, during dynamic exercise tests, healthy individuals experienced a lower decline in oxygen concentration in the back muscles than did patients with LBP [12,13], which means that less oxygen was consumed by the healthy individuals [14]. Tissue oxygenation in the lumbar extensor musculature was reduced as a function of contraction intensity (2% to 30% of maximal voluntary contraction) [12].…”