Changes of paraspinal muscle morphology in patients with chronic non-specific low back pain

Česká verzia

Authors: E. Vagaská ¹; T. Andrašina ² ; S. Voháňka ¹; B. Adamová ¹
Authors place of work: Neurologická klinika LF MU a FN Brno ¹; Radiologická klinika LF MU a FN Brno ²
Published in the journal: Cesk Slov Neurol N 2019; 82(5): 505-512
Category: Přehledný referát
doi: https://doi.org/10.14735/amcsnn2019505

Summary

Low back pain (LBP) is a frequent and major health problem. Paraspinal muscles play an important role in trunk movements, helping to maintain posture and spinal stability. Changes of paraspinal muscle morphology and function are described in patients with chronic LBP. Macroscopic changes can be evaluated by CT and especially by MRI, while microscopic changes are assessed by muscle biopsy. There is evidence available in literature stating that atrophy of paraspinal muscles and increased fat deposits in the paraspinal muscles are significantly associated with non-specific LBP, especially with chronic LBP. From a differential diagnostic point of view, changes in paraspinal muscles associated with LBP must be distinguished from paraspinal muscle involvement in patients with axial myopathies, but these are rare. The aim of this paper is to highlight the structural and functional changes of paraspinal muscles in patients with chronic non-specific LBP. A diagnostic algorithm for chronic LBP associated with degeneration of paraspinal muscles to exclude the presence of axial myopathy is presented.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

Spine – low back pain – paraspinal muscles – fat infiltration – axial myopathies

Zdroje

1. Airaksinen O, Brox JI, Cedraschi C et al. Chapter 4. European guidelines for the management of chronic non--specific low back pain. Eur Spine J 2006; 15 (Suppl 2): S192– S300.

2. Balagué F, Mannion AF, Pellisé F et al. Non-specific low back pain. Lancet 2012; 379(9814): 482– 491. doi: 10.1016/ S0140-6736(11)60610-7.

3. Endean A, Palmer KT, Coggon D. Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine (Phila Pa 1976) 2011; 36(2): 160– 169. doi: 10.1097/ BRS.0b013e3181cd9adb.

4. Kalichman L, Cole R, Kim DH et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J 2009; 9(7): 545– 550. doi: 10.1016/ j.spinee.2009.03.005.

5. Kalichman L, Kim DH, Li L et al. Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain. Spine J 2010; 10(3): 200– 208. doi: 10.1016/ j.spinee.2009.10.018.

6. Cheung KM, Karppinen J, Chan D et al. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976) 2009; 34(9): 934– 940. doi: 10.1097/ BRS.0b013e3181a01b3f.

7. Suri P, Hunter DJ, Rainville J et al. Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage 2013; 21(9): 1199– 1206. doi: 10.1016/ j.joca.2013.05.013.

8. Määttä JH, Wadge S, MacGregor A et al. ISSLS prize winner: vertebral endplate (modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine (Phila Pa 1976) 2015; 40(15): 1187– 1193. doi: 10.1097/ BRS.0000000000000937.

9. Mok FP, Samartzis D, Karppinen J et al. Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J 2016; 16(1): 32– 41. doi: 10.1016/ j.spinee.2015.09.060.

10. Andrasinova T, Adamova B, Buskova J et al. Is therea correlation between degree of radiologic lumbar spinal stenosis and its clinical manifestation? Clin Spine Surg 2018; 31(8): E403– E408. doi: 10.1097/ BSD.0000000000000681.

11. Vagaska E, Litavcova A, Srotova I et al. Do lumbar magnetic resonance imaging changes predict neuropathic pain in patients with chronic non-specific low back pain? Medicine (Baltimore) 2019; 98(17): e15377. doi: 10.1097/ MD.0000000000015377.

12. Berg L, Hellum C, Gjertsen Ø et al. Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal Radiol 2013; 42(11): 1593– 1602. doi: 10.1007/ s00256-013-1700-x.

13. Kalichman L, Carmeli E, Been E. The Association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int 2017; 2017: 2562957. doi: 10.1155/ 2017/ 2562957.

14. Feneis H. Anatomický obrazový slovník. 4. vyd. Praha: Avicenum 1981.

15. Bednařík J, Lukáš Z. Základy anatomie a funkce kosterního svalstva. In: Bednařík J (ed). Nemoci kosterního svalstva. Praha: Triton 2001: 23– 38.

16. Mannion AF. Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. J Electromyogr Kinesiol 1999; 9(6): 363– 377.

17. Agten A, Verbrugghe J, Stevens S et al. Feasibility, accuracy and safety of a percutaneous fine-needle biopsy technique to obtain qualitative muscle samples of the lumbar multifidus and erector spinae muscle in persons with low back pain. J Anat 2018; 233(4): 542– 551. doi: 10.1111/ joa.12867.

18. Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R 2010; 2(2): 142– 146. doi: 10.1016/ j.pmrj.2009.11.006.

19. Nicholas MK, Linton SJ, Watson PJ et al. Early identification and management of psychological risk factors („yellow flags“) in patients with low back pain: a reappraisal. Phys Ther 2011; 91(5): 737– 753. doi: 10.2522/ ptj.20100224.

20. Wan Q, Lin C, Li X et al. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol 2015; 88(1053): 20140546. doi: 10.1259/ bjr.20140546.

21. Sasaki T, Yoshimura N, Hashizume H et al. MRI-defined paraspinal muscle morphology in Japanese population: The Wakayama Spine Study. PLoS One 2017; 12(11): e0187765. doi: 10.1371/ journal.pone.0187765.

22. Goubert D, Oosterwijck JV, Meeus M et al. Structural Changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician 2016; 19(7): E985– E1000.

23. Goutallier D, Postel JM, Bernageau J et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; (304): 78– 83.

24. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000; 55(2): 145– 149. doi: 10.1053/ crad.1999.0340.

25. Kjaer P, Bendix T, Sorensen JS et al. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 2007; 5: 2. doi: 10.1186/ 1741-7015-5-2.

26. Upadhyay B, Toms AP. CT and MRI evaluation of paraspinal muscle degeneration. Poster ECR 2015/ C-2114. doi: 10.1594/ ecr2015/ C-2114.

27. Lee SH, Park SW, Kim YB et al. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. Spine J 2017; 17(1): 81– 87. doi: 10.1016/ j.spinee.2016.08.001.

28. Urrutia J, Besa P, Lobos D et al. Is a single-level measurement of paraspinal muscle fat infiltration and cross--sectional area representative of the entire lumbar spine? Skeletal Radiol 2018; 47(7): 939– 945. doi: 10.1007/ s00256-018-2902-z.

29. Takayama K, Kita T, Nakamura H et al. New Predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine (Phila Pa 1976) 2016; 41(2): E84– E90. doi: 10.1097/ BRS.0000000000001154.

30. 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(4): 742– 748. doi: 10.3174/ ajnr.A4596.

31. Urrutia J, Besa P, Lobos D et al. Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients. Skeletal Radiol 2018; 47(7): 955– 961. doi: 10.1007/ s00256-018-2880-1.

32. Shahidi B, Parra CL, Berry DB et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976) 2017; 42(8): 616– 623. doi: 10.1097/ BRS.0000000000001848.

33. Kalichman L, Hodges P, Li L et al. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 2010; 19(7): 1136– 1144. doi: 10.1007/ s00586-009-1257-5.

34. 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 (Phila Pa 1976) 2004; 29(22): E515– E519. doi: 10.1097/ 01.brs.0000144405.11661.eb.

35. Danneels LA, Vanderstraeten GG, Cambier DC et al. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000; 9(4): 266– 272. doi: 10.1007/ s005860000190.

36. 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 (Phila Pa 19756) 1993; 18(7): 830– 836. doi: 10.1097/ 00007632-199306000-00004.

37. 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(7): 873– 888. doi: 10.2522/ ptj.20120457.

38. 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(7): 1593– 1601. doi: 10.1016/ j.spinee.2015.03.039.

39. D‘hooge R, Cagnie B, Crombez G et al. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther 2012; 17(6): 584– 588. doi: 10.1016/ j.math.2012.06.007.

40. Özcan-Ekşi EE, Ekşi MŞ, Akçal MA. Severe lumbar intervertebral disc degeneration is associated with modic changes and fatty infiltration in the paraspinal muscles at all lumbar levels, except for L1– L2: a cross-sectional analysis of 50 symptomatic women and 50 age-matched symptomatic men. World Neurosurg 2019; 122: e1069-e1077. doi: 10.1016/ j.wneu.2018.10.229.

41. Chen YY, Pao JL, Liaw CK et al. Image changes of paraspinal muscles and clinical correlations in patients with unilateral lumbar spinal stenosis. Eur Spine J 2014; 23(5): 999– 1006. doi: 10.1007/ s00586-013-3148-z.

42. Jiang J, Wang H, Wang L et al. Multifidus degeneration, a new risk factor for lumbar spinal stenosis: a case--control study. World Neurosurg 2017; 99: 226– 231. doi: 10.1016/ j.wneu.2016.11.142.

43. Demoulin C, Crielaard JM, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine 2007; 74(1): 9– 13. doi: 10.1016/ j.jbspin.2006.02.013.

44. Mannion AF, Käser L, Weber E et al. Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. Eur Spine J 2000; 9(4): 273– 281. doi: 10.1007/ s005860000189.

45. Storheim K, Holm I, Gunderson R et al. The effect of comprehensive group training on cross-sectional area, density, and strength of paraspinal muscles in patients sick-listed for subacute low back pain. J Spinal Disord Tech 2003; 16(3): 271– 279.

46. Keller A, Brox JI, Gunderson R et al. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine (phila Pa 1976) 2004; 29(1): 3– 8. doi: 10.1097/ 01.BRS.0000103946.26548.EB.

47. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976) 2001; 26(11): E243– E248. doi: 10.1097/ 00007632-200106010-00004.

48. Ghosh PS, Milone M. Camptocormia as presenting manifestation of a spectrum of myopathic disorders. Muscle Nerve 2015; 52(6): 1008– 1012. doi: 10.1002/ mus.24689.

49. Gáti I, Danielsson O, Gunnarsson C et al. Bent spine syndrome: a phenotype of dysferlinopathy or a symptomatic DYSF gene mutation carrier. Eur Neurol 2012; 67(5): 300– 302. doi: 10.1159/ 000336265

50. Laroche M, Cintas P. Bent spine syndrome (camptocormia): a retrospective study of 63 patients. Joint Bone Spine 2010; 77(6): 593-596. doi: 10.1016/ j.jbspin.2010.05.012.

51. Dahlqvist JR, Vissing CR, Thomsen C et al. Severe paraspinal muscle involvement in facioscapulohumeral muscular dystrophy. Neurology 2014; 83(13): 1178– 1183. doi: 10.1212/ WNL.0000000000000828.

52. Witting N, Andersen LK, Vissing J. Axial myopathy: an overlooked feature of muscle diseases. Brain 2016; 139 (Pt 1): 13– 22. doi: 10.1093/ brain/ awv332.

53. Ghosh PS, Milone M. Clinical and laboratory findings of 21 patients with radiation-induced myopathy. J Neurol Neurosurg Psychiatry 2015; 86(2): 152– 158. doi: 10.1136/ jnnp-2013-307447.

54. Løseth S, Voermans NC, Torbergsen T et al. A novel late-onset axial myopathy associated with mutations in the skeletal muscle ryanodine receptor (RYR1) gene. J Neurol 2013; 260(6): 1504– 1510. doi: 10.1007/ s00415-012-6817-7.