Paraspinal muscle hypotrophy and chronic discogenic low back pain

Open access


Study aim: Low back pain is accompanied by deconditioning of trunk muscles due to pain limiting patients’ physical activity, but so far it has not been explained whether the changes in the structure of muscles are the cause of disc disease or its result. The aim of the study was to analyze the prevalence of segmental paraspinal muscle hypotrophy in patients with chronic low back pain and sciatica. Material and methods: The study involved magnetic resonance imaging (MRI) of 40 patients: 20 women and 20 men aged from 30 to 47, mean 39.51 ± 3.73 years, with single level disc extrusion at L4-L5. The entire cross-sectional area of the par­aspinal muscles, the adipose tissue area in the paraspinal muscles and the extensor muscle tissue area at the level of L4-L5 were measured and compared with the healthy L3-L4 level. T2-weighted axial slices were used to facilitate distinguishing between the muscle and the fat tissue. Results: Fat tissue ingrowth and paravertebral muscle tissue hypotrophy at the disc extrusion level were highly statistically significant (p < 0.001) compared to the healthy level. Conclusions: 1. Ingrowth of the adipose tissue into the muscle tissue occurs only at the level of disc extrusion. 2. It seems rea­sonable to introduce strengthening exercises after the resolution of pain in order to rebuild the muscles of the spine.

1. Ali I., Ulbricht C., McGregor A.H. (2011) Degeneration of the extensor muscle group in a surgical low back and leg pain population. J. Back Musculoskelet. Rehabil., 24(1): 23-30.

2. Barker K.L., Shamley D.R., Jackson D. (2004) 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); 15; 29(22): E515-9.

3. Battié M.C., Niemelainen R., Gibbons L.E., Dhillon S. (2012) CIs level- and side-specific multifidus asymme­try a marker for lumbar disc pathology? Spine J., 12(10): 932-939.

4. Chan S.T., Fung P.K., Ng N.Y., Ngan T.L., Chong M.Y., Tang C.N., He J.F., Zheng Y.P. (2012) Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. Spine J., 12(5): 381-388.

5. Chen J.Y., Ding Y., Lv R.Y., Liu Q.Y., Huang J.B., Yang Z.H., Liu S.L. (2011) Correlation between MR imaging and discography with provocative concordant pain in patients with low back pain. Clin. J. Pain, 27(2): 125-130.

6. Danneels L.A., Vanderstraeten G.G., Cambier D.C., Witvrouw E.E., De Cuyper H.J. (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur. Spine J., 9(4): 266-272.

7. DePalma M.J., Ketchum J.M., Saullo T. (2011). What is the source of chronic low back pain and does age play a role? Pain Med., 12(2): 224-233.

8. Gille O., Jolivet E., Dousset V., Degrise C., Obeid I., Vi­tal J.M., Skalli W. (2007) Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine, 32(11): 1236-1241.

9. Goubert D., De Pauw R., Meeus M., Willems T., Cagnie B., Schouppe S., Van Oosterwijck J., Dhondt E., Dan­neels L. (2017) Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sec­tional study. Spine J., 17(9): 1285-1296. DOI: 10.1016/j.spinee.2017.04.025. Epub 2017 Apr 26.

10. Guo X., Zhang X., Ding W., Yang D., Ma L., Xie D., Wang H., Wang H., Lu K., Yang S. (2014) Imaging studyof paravertebral muscle degeneration in degenerative lumbar instability. Zhonghua Wai Ke Za Zhi.; 52(8): 571-575.

11. Hodges P., Holm A.K., Hansson T., Holm S. (2006) Rap­id atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976).;1, 31(25): 2926-2933.

12. Kader D.F., Wardlaw D., Smith F.W. (2000) Correlation between the MRI changes in the lumbar multifidus mus­cles and leg pain. Clin. Radiol., 55(2): 145-149

13. Kjaer P., Bendix T., Sorensen J.S., Korsholm L., Leb­oeuf-Yde C. (2007) Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med., 5: 2.

14. Lee J.C., Cha J.G., Kim Y., Kim Y.I., Shin B.J. (2008) 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 (Phila Pa 1976)., 1, 33(3): 318-325. DOI: 10.1097/BRS.0b013e318162458f.

15. Maniadakis N., Gray A. (2000) The economic burden of back pain in the UK. Pain, 84(1): 95-103.

16. Mannion A.F., Käser L., Weber E., Rhyner A., Dvorak J., Müntener M. (2000) 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., 9(4): 273-281.

17. Mengiardi B., Schmid M.R., Boos N., Pfirrmann C.W., Brunner F., Elfering A., Hodler J. (2006) Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology, 240(3): 786-792.

18. Niemeläinen R., Briand M.M., Battié M.C. (2011) Sub­stantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine (Phila Pa 1976), 1; 36(25): 2152-2157.

19. Ranson C.A., Burnett A.F., Kerslake R., Batt M.E., O’Sullivan P.B. (2006) An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles, Eur. Spine J., 15(6): 764-773.

20. Rintala H., Sovelius R., Rintala P., Huhtala H., Siito­nen S., Kyröläinen H. (2017) MRI findings and physical performance as predictors of flight-induced musculoskel­etal pain incidence among fighter pilots. Biomed. Hum. Kinet., 9, 133-139. DOI: 10.1515/bhk-2017-0019.

21. Ropponen A., Videman T., Battié M.C. (2008) The reli­ability of paraspinal muscles composition measurements using routine spine MRI and their association with back function. Man. Ther., 13(4): 349-356.

22. Shahidi B., Hubbard J.C., Gibbons M.C., Ruoss S., Zlo­mislic V., Allen R.T., Garfin S.R., Ward S.R. (2017) Lum­bar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology. J. Orthop. Res., 8. DOI: 10.1002/jor.23597. [Epub ahead of print].

23. Smith M., Davis M.A., Stano M., Whedon J.M. (2013) Aging baby boomers and the rising cost of chronic back pain: secular trend analysis of longitudinal Medical Ex­penditures Panel Survey data for years 2000 to 2007. J. Manipulative Physiol. Ther., 36(1): 2-11. DOI: 10.1016/j.jmpt.2012.12.001.

24. Wallwork T.L., Stanton W.R., Freke M., Hides J.A. (2009) The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther., 14(5): 496-500.

Biomedical Human Kinetics

The Journal of University of Physical Education, Warsaw

Journal Information

SCImago Journal Rank (SJR) 2017: 0.123


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 304 262 23
PDF Downloads 141 134 15