Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation

Fortin, Maryse; Lazáry, Áron; Varga, Péter; McCall, Iain W.; Battié, Michele C.

doi:10.1007/s00586-016-4503-7

Cited by 94 publications

(118 citation statements)

References 29 publications

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“…4). [3, 4, 14, 19]. This is supported by histological findings in chronical lumbar spine diseases showing an increase of degenerative changes in the multifidus muscles which occur as decrease of the cross sectional area, reduction of type II fibers, signs of inflammation and decreased vascularity [20].…”

Section: Discussionmentioning

confidence: 89%

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

Gilbert

Heintel

Jakubietz

et al. 2018

BMC Musculoskelet Disord

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BackgroundMinimally invasive pedicle screw fixation has less approach-related morbidity than open screw placement and is allegedly less traumatizing on paravertebral muscles, as there is no requirement to mobilize and retract the adjacent muscle portion. The approach-related long-term effects to the morphology of the paravertebral muscles are unknown. The purpose of this study was to compare the long-term amount of fatty degeneration of the multifidus muscle in patients treated with a classical open or a minimally invasive approach.MethodsFourteen Patients meeting inclusion criteria were selected. In all patients a singular fracture of the thoracolumbar spine with a two-level posterior instrumentation was treated, either using an open approach or a minimally invasive approach. All patients underwent quantitative MRI spectroscopy for quantification of the fatty degeneration in the multifidus muscle as a long-term proof for muscle loss after minimum 4-year follow-up. Clinical outcome was assessed using Oswestry Low Back Pain Disability Questionnaire, SF-36 and VA-scale for pain.ResultsThe minimally invasive approach group failed to show less muscle degeneration in comparison to the open group. Total amount of fatty degeneration was 14.22% in the MIS group and 12.60% in the open group (p = 0.64). In accordance to MRI quantitative results there was no difference in the clinical outcome after a mean follow up of 5.9 years (±1.8).ConclusionAs short-term advantages of minimal invasive screw placement have been widely demonstrated, no advantage of the MIS, displaying a significant difference in the amount of fatty degeneration and resulting in a better clinical outcome could be found. Besides the well-known short-term advantage of minimally invasive pedicle screw placement, a long-term advantage, such as less muscle degeneration and thus superior clinical results, compared to the open approach could not be shown.

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Section: Discussionmentioning

confidence: 89%

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

Gilbert

Heintel

Jakubietz

et al. 2018

BMC Musculoskelet Disord

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“…Each study employed slightly different measurements in defining fatty infiltration. Fortin et al's [33] MRI study measured fatty infiltration in two different ways: (1) the ratio of fat CSA to total CSA as an indicator of muscle composition (or fatty infiltration) and (2) signal intensity as an indicator of fatty infiltration. In another MRI study, Hebert et al [34] also used signal intensity to separate muscle from fat.…”

Section: Resultsmentioning

confidence: 99%

“…Their results are presented as percentages of the fat CSA from the total muscle CSA. Niemeläinen et al [35] used the ratio of fat CSA to total CSA as an indicator of muscle composition similar to Fortin et al [33]. Chan et al [27] referred to fat CSA (cm 2 ) as an indicator of fatty infiltration.…”

Section: Resultsmentioning

confidence: 99%

The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain

Kalichman

Carmeli

Been

2017

BioMed Research International

185

179

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This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.

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“…Supporting our finding from the literature Dannels et al [15] with 23 healthy volunteers and 32 LBP patients study mentioned the small size of multifidus at the lower end-plate of L4 vertebra particularly. Fortin et al [12] highlighted the L4-5 level in another study including 33 patients diagnosed with posterolateral disc herniation at L4-L5 and found the erector spinae FCSA (functional cross sectional area) and the ratio of FCSA/ CSA was smaller on the side of the herniation at L4-5. In our study we would like to take attention to the L2-3 level.…”

Section: Discussionmentioning

confidence: 98%

“…[7][8][9][11][12][13][14][15][16][17] Here, we presented a multiparameter involved complex study which analysed the hernia grading, bilateral PSM muscle lengths, and BMI.…”

mentioning

confidence: 99%

The effect of paraspinal muscles on the lumbar disc herniation

Turkoglu

Türkoğlu

2017

EJMO

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T he lumbar disc degeneration is very common problem among patients. Patients with this problem are diagnosed usually with the symptom of low back pain (LBP) which is followed by lumbar MRI (magnetic resonans imagination). [1,2] During the evaluation of a lumbar MRI the changes in the paraspinal muscles (PSM) are usually overlooked in clinical routine. The diagnosis of disc herniation has been associated with many factors in the literature such as body weight, height and high body mass index (BMI). [3][4][5][6] Lumbar PSM is composed of iliocostalis, longissimus and spinalis called PS errector muscle group and multifidus muscle. The PSM support the spine, maintain posture, and assist in trunk movements. Their funtion of postural control and lumbar movement perception is very important in stabilization of disc herniation. The role of PSM in hernia formation have not been questioned directly.[7-10] However, there have been many studies relating the paraspinal muscles atrophy, asymmetry, or fatty infiltration to the LBP problems. [7][8][9][11][12][13][14][15][16][17] Here, we presented a multiparameter involved complex study which analysed the hernia grading, bilateral PSM muscle lengths, and BMI. Materials and MethodsSeventy patients 40 (58%) females and 30 (42%) males, age range 30-50; mean age 47.2±13.5 years were studied. The lumbar MRI of LBP patients from the records of Radiology Objectives: Lumbar disc degeneration is diagnosed with radiological signs in the paraspinal muscles (PSM) seen on lumbar magnetic resonance imaging. It is associated with body weight, height, and a high body mass index (BMI). The role of the PSM has not been examined in the literature. The aim of this study was to analyze hernia grading, bilateral PSM length, and BMI. Methods: The grading of herniation size and the anteroposterior (AP) length of the bilateral PSM and their distance to the skin was assessed at lumbar intervertebral levels in 70 patients with low back pain. Data collected were the bilateral AP lengths of the psoas and PS erector muscle group, Modic type endplate degeneration, and hernia grade at each intervertebral level from L1 to S1. Patients' age, sex, and BMI were also recorded. Results: The hernia grades 0-1 were common at the L1-L2, L2-L3, and L3-L4 levels with statistical significance, and hernia grades 2-3 were common at the L4-L5 and L5-S1 levels. The mean age of the patients with a normal BMI was lower than that of the patients who were overweight or obese. The mean age was associated with hernia grade only at the L2-L3 and L3-L4 levels, and it was also related to the right side AP length of the PSM at the L2-L3 and bilateral psoas to skin distance at L3-L4. BMI was not associated with any AP length of bilateral PSM except at the L5-S1 level. There was a correlation between hernia grade 0 and AP length of the right PSM at the L2-L3 level and the left PSM at the L4-L5 level. Conclusion: PSM atrophy was not related to the severity of hernia or pain, and control of BMI may be effective for hernia. Further studie...

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Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation

Cited by 94 publications

References 29 publications

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain

The effect of paraspinal muscles on the lumbar disc herniation

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