The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain

Dreyfuss, Paul; Stout, Alison; Aprill, Charles; Pollei, Steve; Johnson, Bernadette; Bogduk, Nikolai

doi:10.1016/j.pmrj.2009.05.014

Cited by 54 publications

(39 citation statements)

References 16 publications

(36 reference statements)

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“…Radiofrequency neurotomy interventions, which denervate the multifidus muscle, have been shown to attenuate the psychophysical signs/symptoms of whiplash (eg, reduced thermal/pressure pain thresholds) 21 and low back pain. 3 However, considering the known resolution of facetogenic pain, the long-term consequences of radiofrequency neurotomy on the structure and function of the deep cervical muscles (and lumbar muscles 3,22 ) are largely unknown. It is notable that none of the participants in this study had undergone a radiofrequency neurotomy procedure.…”

Section: Discussionmentioning

confidence: 99%

The Geography of Fatty Infiltrates Within the Cervical Multifidus and Semispinalis Cervicis in Individuals With Chronic Whiplash-Associated Disorders

Abbott¹,

Pedler²,

Sterling³

et al. 2015

J Orthop Sports Phys Ther

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Previous studies using magnetic resonance imaging (MRI) have revealed widespread fatty infiltrates in the neck extensor 5 and flexor 8 muscles of individuals with chronic whiplash-associated disorders (WADs). These high levels of muscle fat infiltration (MFI) were not present in those with chronic nontraumatic neck pain 6 or those without a history of neck disorders.5 While widespread, the greatest magnitude of MFI was consistently observed in the deepest muscular layer of the extensors (eg, the multifidus and semispinalis cervicis) when compared to the more superficial musculature (eg, semispinalis capitis, splenius capitis, and upper trapezius). 5,9The specific role of MFI in the development and maintenance of chronic WAD is not fully understood.7,24 Improvements in our mechanistic understanding of the development of structural changes (eg, composition and morphology) in the cervical muscles of patients with chronic WAD may shed light on their potential contribution to poor functional recovery. T T STUDY DESIGN:Cross-sectional. T T OBJECTIVES:To quantify the magnitude and distribution of muscle fat infiltration (MFI) within the cervical multifidus and semispinalis cervicis muscles in participants with chronic whiplashassociated disorders (WADs) compared to those who have fully recovered from a whiplash injury and healthy controls. T T BACKGROUND: Previous research has estab-lished the presence of increased MFI throughout the cervical extensor muscles of individuals with WAD when compared to healthy controls. These changes appear to be greater in the deepest muscles (eg, multifidus and semispinalis cervicis) than in the more superficial muscles. A detailed analysis of the distribution of MFI within these deep extensor muscles in chronic WAD, recovered, and control groups would provide a foundation for further investigation of specific mechanisms, etiologies, and targets for treatments. T T METHODS:Fifteen participants (WAD, n = 5; recovered, n = 5; and control, n = 5) were studied using a 3-D fat-water separation magnetic resonance imaging sequence. Bilateral measures of cervical multifidus and semispinalis cervicis MFI in 4 quartiles (1 [medial] to 4 [lateral]) at cervical levels C3 through C7 were included in the analysis. Intrarater and interrater reliability were established. A mixed-model analysis was performed to control for covariates, identify interaction effects, and compare MFI distribution between groups. T T RESULTS:The limits of agreement confirmed strong intrarater and interrater agreement at all levels (C3-C7). Sex, age, and body mass index were identified as significant covariates for MFI. Significant interactions were found between group and muscle quartile (P<.001) and between muscle quartile and cervical level (P<.001). Pairwise comparisons for intraquartile MFI between groups revealed significantly greater MFI in the WAD group when compared to the recovered group in the first quartile (P<.001), second quartile (P<.001), and third quartile (P = .03). When compared to the control group, the WA...

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Section: Discussionmentioning

confidence: 99%

The Geography of Fatty Infiltrates Within the Cervical Multifidus and Semispinalis Cervicis in Individuals With Chronic Whiplash-Associated Disorders

Abbott¹,

Pedler²,

Sterling³

et al. 2015

J Orthop Sports Phys Ther

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“…Therefore, we were unable to comment on how the diagnosis of LDRS might affect clinical decision making. In a small clinical study of 5 patients, Dreyfuss et al [26] demonstrated diffuse lumbar multifidus atrophy after unilateral radiofrequency neurotomy. Their small sample experienced persistent pain relief up to 12 months.…”

Section: Discussionmentioning

confidence: 99%

Does Lumbar Dorsal Ramus Syndrome Have an Objective Clinical Basis?

Annaswamy

Bierner

Doppalapudi

2013

PM&R

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“…36 However, a clinical study found that coagulation of the medial branch produced no detectable disability. 40 Despite extensive denervation of the multifidus, the patients had no symptoms and remained relieved of their back pain. 41…”

Section: Clinical Relevance and Radiofrequency Neurolysis Of The Facementioning

confidence: 96%

Analysis of the Posterior Ramus of the Lumbar Spinal Nerve

Saito

Steinke

Miyaki³

et al. 2013

Anesthesiology

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The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain

Cited by 54 publications

References 16 publications

The Geography of Fatty Infiltrates Within the Cervical Multifidus and Semispinalis Cervicis in Individuals With Chronic Whiplash-Associated Disorders

The Geography of Fatty Infiltrates Within the Cervical Multifidus and Semispinalis Cervicis in Individuals With Chronic Whiplash-Associated Disorders

Does Lumbar Dorsal Ramus Syndrome Have an Objective Clinical Basis?

Analysis of the Posterior Ramus of the Lumbar Spinal Nerve

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