J Neurol Surg A Cent Eur Neurosurg 2018; 79(04): 323-329
DOI: 10.1055/s-0038-1639332
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Paraspinal Muscles of Patients with Lumbar Diseases

Moon Soo Park
1   Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, Korea (the Republic of)
,
Seong-Hwan Moon
2   Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
,
Tae-Hwan Kim
1   Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, Korea (the Republic of)
,
JaeKeun Oh
3   Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea, Republic of
,
Seon-Jong Lee
1   Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, Korea (the Republic of)
,
Ho Guen Chang
1   Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, Korea (the Republic of)
,
Jae-Hyuk Shin
4   Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea (the Republic of)
› Author Affiliations
Further Information

Publication History

30 July 2017

09 November 2017

Publication Date:
16 April 2018 (online)

Abstract

Objective The treatment of atrophy or increased fat infiltration of the lumbar paraspinal muscles of patients with back pain, lumbar radiculopathy, or lumbar degenerative kyphosis is controversial. We review the literature on changes in the lumbar paraspinal muscles of these patients.

Methods We searched Medline for relevant English-language articles and retrieved 25 articles published from 1993 to 2017 on changes in the lumbar paraspinal muscles; 21 met our study criteria. We categorized each article into three groups: randomized clinical trial, nonrandomized prospective study, or retrospective study.

Results We found 1 randomized prospective, 3 nonrandomized prospective, and 17 retrospective studies. Atrophies of the multifidus muscle are found at the level of the L5 vertebral body in patients with back pain, lumbar radiculopathy, and lumbar degenerative kyphosis. Increased fat infiltration to the multifidus muscle was found in the patients with lumbar radiculopathy or lumbar degenerative kyphosis. However, there are controversies over fat infiltration to the multifidus muscle in the patients with back pain and the efficiency of a paramedian surgical approach to prevent the atrophy of the multifidus muscle.

Conclusions Atrophy of the multifidus muscle was found in patients with back pain, lumbar radiculopathy, and lumbar degenerative kyphosis. There was increased fat infiltration to the multifidus muscle in those patients with lumbar radiculopathy or lumbar degenerative kyphosis.

 
  • References

  • 1 Hides JA, Richardson CA, Jull GA. Magnetic resonance imaging and ultrasonography of the lumbar multifidus muscle. Comparison of two different modalities. Spine 1995; 20 (01) 54-58
  • 2 Stokes M, Rankin G, Newham DJ. Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique. Man Ther 2005; 10 (02) 116-126
  • 3 Crawford RJ, Filli L, Elliott JM. , et al. Age- and level-dependence of fatty infiltration in lumbar paravertebral muscles of healthy volunteers. AJNR Am J Neuroradiol 2016; 37 (04) 742-748
  • 4 Lee SH, Park SW, Kim YB, Nam TK, Lee YS. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. Spine J 2017; 17 (01) 81-87
  • 5 Sions JM, Coyle PC, Velasco TO, Elliott JM, Hicks GE. Multifidi muscle characteristics and physical function among older adults with and without chronic low back pain. Arch Phys Med Rehabil 2017; 98 (01) 51-57
  • 6 Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Phys Ther 2013; 93 (07) 873-888
  • 7 Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician 2016; 19 (07) E985-E1000
  • 8 Ranger TA, Cicuttini FM, Jensen TS. , et al. Is the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J 2017; July 26 (Epub ahead of print)
  • 9 Fortin M, Battié MC. Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther 2012; 92 (06) 853-864
  • 10 Lee SW, Chan CK, Lam TS. , et al. Relationship between low back pain and lumbar multifidus size at different postures. Spine 2006; 31 (19) 2258-2262
  • 11 Chan ST, Fung PK, Ng NY. , et al. Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. Spine J 2012; 12 (05) 381-388
  • 12 Shahidi B, Parra CL, Berry DB. , et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine 2017; 42 (08) 616-623
  • 13 Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine 2004; 29 (22) E515-E519
  • 14 Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol 2011; 84 (1004): 709-713
  • 15 Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 1994; 19 (02) 165-172
  • 16 Wan Q, Lin C, Li X, Zeng W, Ma C. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol 2015; 88 (1053): 20140546
  • 17 D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther 2012; 17 (06) 584-588
  • 18 Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008; 13 (01) 43-49
  • 19 Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther 2009; 14 (05) 496-500
  • 20 Hebert JJ, Kjaer P, Fritz JM, Walker BF. The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study. Spine 2014; 39 (17) 1417-1425
  • 21 Parkkola R, Rytökoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 1993; 18 (07) 830-836
  • 22 Mengiardi B, Schmid MR, Boos N. , et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 2006; 240 (03) 786-792
  • 23 Teichtahl AJ, Urquhart DM, Wang Y. , et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 2015; 15 (07) 1593-1601
  • 24 Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000; 9 (04) 266-272
  • 25 Paalanne N, Niinimäki J, Karppinen J. , et al. Assessment of association between low back pain and paraspinal muscle atrophy using opposed-phase magnetic resonance imaging: a population-based study among young adults. Spine 2011; 36 (23) 1961-1968
  • 26 Battié MC, Niemelainen R, Gibbons LE, Dhillon S. Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology?. Spine J 2012; 12 (10) 932-939
  • 27 Kim WH, Lee SH, Lee DY. Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc 2011; 50 (03) 201-204
  • 28 Fortin M, Lazáry À, Varga PP, McCall I, Battié MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J 2016; 25 (05) 1452-1459
  • 29 Lee JC, Cha JG, Kim Y, Kim YI, Shin BJ. Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine 2008; 33 (03) 318-325
  • 30 Hyun SJ, Bae CW, Lee SH, Rhim SC. Fatty degeneration of the paraspinal muscle in patients with degenerative lumbar kyphosis: a new evaluation method of quantitative digital analysis using MRI and CT scan. Clin Spine Surg 2016; 29 (10) 441-447
  • 31 Min SH, Kim MH, Seo JB, Lee JY, Lee DH. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J 2009; 3 (02) 89-95
  • 32 Hyun SJ, Kim YB, Kim YS. , et al. Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion. J Korean Med Sci 2007; 22 (04) 646-651
  • 33 Putzier M, Hartwig T, Hoff EK, Streitparth F, Strube P. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF—a prospective randomized clinical trial. Spine J 2016; 16 (07) 811-819
  • 34 Alaranta H, Tallroth K, Soukka A, Heliövaara M. Fat content of lumbar extensor muscles and low back disability: a radiographic and clinical comparison. J Spinal Disord 1993; 6 (02) 137-140
  • 35 Hildebrandt M, Fankhauser G, Meichtry A, Luomajoki H. Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain. BMC Musculoskelet Disord 2017; 18 (01) 12
  • 36 Goubert D, De Pauw R, Meeus M. , et al. Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study. Spine J 2017; 17 (09) 1285-1296