The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression

Abstract

Background The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy). Methods The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared. Results No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively). Conclusions The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.

The impact of protrusion size on pain, range of motion, functional capacity, and multifidus muscle cross-sectional area in lumbar disc herniation

“…Indeed, another study conducted by the same authors demonstrated that fat infiltration exhibited a significant correlation with root compression, and the severity of fat filtration further escalated when root compression was present. [15] In our study, in which the multifidus cross-sectional area was calculated in patients with nerve compression, we found that the amount of protrusion had no effect on the cross-sectional area of the lumbar multifidus muscle. However, this was thought to be due to the measurement of the total cross-sectional area without isolating the fat infiltrates in the muscle, while calculating the cross-sectional area of the lumbar multifidus muscle.…”

“…There are studies in the literature on pain, physical function, and the cross-sectional area of the multifidus muscle in individuals with lumbar disc herniation. [13,14] Although there is a study demonstrating a correlation between lumbar disc herniation and paraspinal muscle degeneration, indicating that severe fat infiltration is associated with nerve root compression, and the severity of fat infiltration increases in the presence of nerve root compression, [15] we have not come across any research investigating the impact of protrusion size in lumbar disc herniation on pain, lumbar mobility, physical function, and the cross-sectional area of the lumbar multifidus muscle. This study was designed with the aim of exploring the relationship between the symptoms and the radiologically detected disc herniation and how it may manifest in the clinical presentation.…”

Association between the Thickness of Lumbar Subcutaneous Fat Tissue and the Presence of Hernias in Adults with Persistent, Non-Traumatic Low Back Pain

“…Obesity measured using BMI or LFSTT is not the only risk factor for the development of lumbar hernias; however, different lumbar hernia prevalence rates have been reported depending on the area of the world where the study was conducted. Therefore, patients should be staged according to the states or countries where they reside or have lived most of their lives, as well as by their different ethnicities, races, and other socioeconomic and cultural conditions that may be risk factors for the increased presence of hernial defects in discs [ 19 , 20 , 21 ].…”

The association between morphological characteristics of paraspinal muscle and spinal disorders

“…A cross-section study showed a correlation demonstrated between LDH and paraspinal muscles [ 132 ]. Some retrospective studies provide evidence for this viewpoint.…”

“…Yazici et al. conducted a cross-section study and reported a correlation between the FI of the paraspinal muscles and LDH but did not find any correlation with asymmetry [ 132 ]. It is important to note that these conclusions may be attributed to differences in the study populations, methods, sample sizes, and other factors.…”