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James G, Ahern BJ, Goodwin W, Goss B, Hodges PW. Targeted multifidus muscle activation reduces fibrosis of multifidus muscle following intervertebral disc injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08234-5. [PMID: 38607406 DOI: 10.1007/s00586-024-08234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/05/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Aerobic exercise produces beneficial outcomes in patients with low back pain and partially attenuates the fibrotic changes to the multifidus in a model of intervertebral disc (IVD) degeneration. More targeted exercise might be required to fully attenuate these fibrotic alterations. This study aimed to investigate whether activation of the multifidus induced by neurostimulation could reduce fibrosis of the multifidus in a model of IVD degeneration in sheep. METHODS IVD degeneration was induced in 18 merino sheep via a partial thickness unilateral annulus fibrosus lesion to the L1/2 and L3/4 IVDs. All sheep received an implantable neurostimulation device that provides stimulation of the L2 medial branch of the dorsal ramus. Three months after surgery, the animals were assigned to Injury or Activated groups. Activated animals received neurostimulation and the Injury group received no stimulation. Six months after surgery, the multifidus was harvested at L2 and L4. Van Gieson's, Sirius Red and immunofluorescence staining for Collagen-I and -III and quantitative PCR was used to examine fibrosis. Muscle harvested from a previous study without IVD injury was used as a control. RESULTS Neurostimulation of the multifidus attenuated IVD degeneration dependent increases in the connective tissue, including Collagen-I but not Collagen-III, compared to the Injury group at L4. No measures of the multifidus muscle at L2, which received no stimulation, differed between the Injury and Activated groups. CONCLUSIONS These data reveal that targeted activation of the multifidus muscle attenuates IVD degeneration dependent fibrotic alterations to the multifidus.
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Affiliation(s)
- G James
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - B J Ahern
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - W Goodwin
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - B Goss
- Mainstay Medical, San Diego, USA
| | - P W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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Schönnagel L, Chiaparelli E, Camino-Willhuber G, Zhu J, Caffard T, Tani S, Burkhard MD, Kelly M, Guven AE, Shue J, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Spine-specific sarcopenia: distinguishing paraspinal muscle atrophy from generalized sarcopenia. Spine J 2024:S1529-9430(24)00099-8. [PMID: 38432297 DOI: 10.1016/j.spinee.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND CONTEXT Atrophy of the paraspinal musculature (PM) as well as generalized sarcopenia are increasingly reported as important parameters for clinical outcomes in the field of spine surgery. Despite growing awareness and potential similarities between both conditions, the relationship between "generalized" and "spine-specific" sarcopenia is unclear. PURPOSE To investigate the association between generalized and spine-specific sarcopenia. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing lumbar spinal fusion surgery for degenerative spinal pathologies. OUTCOME MEASURES Generalized sarcopenia was evaluated with the short physical performance battery (SPPB), grip strength, and the psoas index, while spine-specific sarcopenia was evaluated by measuring fatty infiltration (FI) of the PM. METHODS We used custom software written in MATLAB® to calculate the FI of the PM. The correlation between FI of the PM and assessments of generalized sarcopenia was calculated using Spearman's rank correlation coefficient (rho). The strength of the correlation was evaluated according to established cut-offs: negligible: 0-0.3, low: 0.3-0.5, moderate: 0.5-0.7, high: 0.7-0.9, and very high≥0.9. In a Receiver Operating Characteristics (ROC) analysis, the Area Under the Curve (AUC) of sarcopenia assessments to predict severe multifidus atrophy (FI≥50%) was calculated. In a secondary analysis, factors associated with severe multifidus atrophy in non-sarcopenic patients were analyzed. RESULTS A total of 125 (43% female) patients, with a median age of 63 (IQR 55-73) were included. The most common surgical indication was lumbar spinal stenosis (79.5%). The median FI of the multifidus was 45.5% (IQR 35.6-55.2). Grip strength demonstrated the highest correlation with FI of the multifidus and erector spinae (rho=-0.43 and -0.32, p<.001); the other correlations were significant (p<.05) but lower in strength. In the AUC analysis, the AUC was 0.61 for the SPPB, 0.71 for grip strength, and 0.72 for the psoas index. The latter two were worse in female patients, with an AUC of 0.48 and 0.49. Facet joint arthropathy (OR: 1.26, 95% CI: 1.11-1.47, p=.001) and foraminal stenosis (OR: 1.54, 95% CI: 1.10-2.23, p=.015) were independently associated with severe multifidus atrophy in our secondary analysis. CONCLUSION Our study demonstrates a low correlation between generalized and spine-specific sarcopenia. These findings highlight the risk of misdiagnosis when relying on screening tools for general sarcopenia and suggest that general and spine-specific sarcopenia may have distinct etiologies.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Luisenstraße 64, 10117 Berlin, Germany
| | - Erika Chiaparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Asuncion Klinikia, Izaskungo Aldapa, 20400 Tolosa, Spain
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Soji Tani
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Tokyo, Japan
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Michael Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA.
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Liu Z, Wang Y, Ma X, Zhang L, Wang C. Role of epidural fat in the local milieu: what we know and what we don't. Connect Tissue Res 2024; 65:102-116. [PMID: 38493368 DOI: 10.1080/03008207.2024.2329871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Traditionally, the epidural fat (EF) is known as a physical buffer for the dural sac against the force and a lubricant facilitating the relative motion of the latter on the osseous spine. Along with the development of the studies on EF, controversies still exist on vital questions, such as the underlying mechanism of the spinal epidural lipomatosis. Meanwhile, the scattered and fragmented researches hinder the global insight into the seemingly dispensable tissue. METHODS Herein, we reviewed literature on the EF and its derivatives to elucidate the dynamic change and complex function of EF in the local milieu, especially at the pathophysiological conditions. We start with an introduction to EF and the current pathogenic landscape, emphasizing the interlink between the EF and adjacent structures. We generally categorize the major pathological changes of the EF into hypertrophy, atrophy, and inflammation. RESULTS AND CONCLUSIONS It is acknowledged that not only the EF (or its cellular components) may be influenced by various endogenic/exogenic and focal/systematic stimuli, but the adjacent structures can also in turn be affected by the EF, which may be a hidden pathogenic clue for specific spinal disease. Meanwhile, the unrevealed sections, which are also the directions the future research, are proposed according to the objective result and rational inference. Further effort should be taken to reveal the underlying mechanism and develop novel therapeutic pathways for the relevant diseases.
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Affiliation(s)
- Zhiming Liu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yida Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Department of Medical Research Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chao Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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Chen X, Wang W, Cui P, Li Y, Lu S. Evidence of MRI image features and inflammatory biomarkers association with low back pain in patients with lumbar disc herniation. Spine J 2024:S1529-9430(24)00079-2. [PMID: 38360179 DOI: 10.1016/j.spinee.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/12/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND CONTEXT While MRI image features and inflammatory biomarkers are frequently used for guiding treatment decisions in patients with lumbar disc herniation (LDH) and low back pain (LBP), our understanding of the connections between these features and LBP remains incomplete. There is a growing interest in the potential significance of MRI image features and inflammatory biomarkers, both for quantification and as emerging therapeutic tools for LBP. PURPOSE To investigate the evidence supporting MRI image features and inflammatory biomarkers as predictors of LBP and to determine their relationship with pain intensity. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE All consecutive patients with LDH who underwent discectomy surgery at our institution from February 2020 to June 2023 at the author's institution were included. OUTCOME MEASURES MRI image features in discogenic, osseous, facetogenic, and paraspinal muscles, as well as inflammatory biomarkers in serum (including CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), PCT (procalcitonin), TNF (tumor necrosis factor), interleukin-1 beta (IL-1β), and IL-6), and paraspinal muscles (including TNF, IL-1β, IL-6, IL-10, and transforming growth factor beta 1 (TGF-β1)). METHODS A series of continuous patients diagnosed with LDH were categorized into acute LBP (<12 weeks), chronic LBP (≥12 weeks), and non-LBP groups. MRI image features and inflammatory biomarkers relation to pain intensity was assessed using the independent t-test, Chi-squared tests, Spearman rank correlation coefficient, and logistic regression test. RESULTS Compared to the non-LBP group, the chronic LBP group exhibited a higher incidence of intervertebral disc (IVD) degeneration (≥ grade 3) and high-fat infiltration in paraspinal muscles, alongside a significant reduction in the cross-sectional area (CSA) and fatty degeneration of the multifidus muscle. Furthermore, there was a greater expression of IL-6 in serum and TNF in paraspinal muscles in the chronic LBP group and a greater expression of CRP and IL-6 in serum and TNF in paraspinal muscles in the acute LBP group. CSA and fatty degeneration of multifidus muscle were moderately negatively correlated with chronic LBP scores. The expression of TNF and IL-6 in serum and the expression of TNF in the multifidus muscle were moderately correlated with preoperative LBP. IVD degeneration and high-fat infiltration were identified as risk factors for chronic LBP. CONCLUSION The results provide evidence that IVD degeneration, high-fat infiltration, and the reduction of CSA in paraspinal muscles were associated with the development of chronic LBP in patients with LDH, and these associations are linked to inflammatory regulation. This deepens our understanding of the etiology and pathophysiology of LBP, potentially leading to improved patient stratification and more targeted interventions.
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Affiliation(s)
- Xiaolong Chen
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Peng Cui
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Yongjin Li
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, China.
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Tieppo Francio V, Westerhaus BD, Carayannopoulos AG, Sayed D. Multifidus dysfunction and restorative neurostimulation: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1341-1354. [PMID: 37439698 PMCID: PMC10690869 DOI: 10.1093/pm/pnad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. METHODS A scoping review of the literature. RESULTS In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. CONCLUSIONS Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Benjamin D Westerhaus
- Cantor Spine Institute at the Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, United States
| | - Alexios G Carayannopoulos
- Department of Neurosurgery and Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
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Minetama M, Kawakami M, Nakatani T, Teraguchi M, Nakagawa M, Yamamoto Y, Matsuo S, Sakon N, Nakagawa Y. Lumbar paraspinal muscle morphology is associated with spinal degeneration in patients with lumbar spinal stenosis. Spine J 2023; 23:1630-1640. [PMID: 37394143 DOI: 10.1016/j.spinee.2023.06.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) has been reported to induce changes in paraspinal muscle morphology, but objective physical function and degenerative spine conditions are rarely assessed. PURPOSE To identify factors associated with paraspinal muscle morphology using objective physical and degenerative spine assessments in patients with LSS. STUDY DESIGN/SETTING Cross-sectional design. PATIENT SAMPLE Seventy patients with neurogenic claudication caused by LSS, receiving outpatient physical therapy. OUTCOME MEASURES Cross-sectional area (CSA) and functional CSA (FCSA) of the multifidus, erector spinae, and psoas muscles, the severity of stenosis, disc degeneration, and endplate abnormalities were evaluated by magnetic resonance imaging, as well as sagittal spinopelvic alignment by X-ray. Objective physical assessments included pedometry and claudication distance. Patient-reported outcomes included the numerical rating scale of low back pain, leg pain, and leg numbness, and the Zurich Claudication Questionnaire. METHODS To assess the impact of LSS on paraspinal muscles, FCSA and FCSA/CSA were compared between the dominant and nondominant sides based on the patients' neurogenic symptoms, and multivariable regression analyses adjusted for age, sex, height, and weight were performed; p<.05 was considered significant. RESULTS Seventy patients were analyzed. At one level below the maximum stenotic level, erector spinae FCSA on the dominant side was significantly lower than that on the nondominant side. In the multivariable regression analyses, at one level below the symptomatic level, disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment, such as decreased lumbar lordosis and increased pelvic tilt, were negatively associated with multifidus FCSA and FCSA/CSA ratio. A significant association was observed between dural sac CSA and erector spinae FCSA. Throughout L1/2 to L5/S, disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment were negatively associated with multifidus and erector spinae FCSA or FCSA/CSA. CONCLUSIONS Lumbar paraspinal muscle asymmetry caused by LSS was observed only in erector spinae. Disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment, rather than spinal stenosis and LSS symptoms, were more associated with paraspinal muscle atrophy or fat infiltration.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan; Department of Orthopedic Surgery, Saiseikai Wakayama Hospital, 45 Jyunibancho, Wakayama city, Wakayama, 640-8158, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
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Fortin M, Rye M, Roussac A, Montpetit C, Burdick J, Naghdi N, Rosenstein B, Bertrand C, Macedo LG, Elliott JM, Dover G, DeMont R, Weber MH, Pepin V. The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2023; 12:5920. [PMID: 37762861 PMCID: PMC10532355 DOI: 10.3390/jcm12185920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
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Affiliation(s)
- Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Cleo Bertrand
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Luciana G. Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - James M. Elliott
- Faculty of Medicine and Health, School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, NSW 2050, Australia;
- Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Michael H. Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC H3J 1A4, Canada;
| | - Véronique Pepin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
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Park J, Cho YE, Kim KH, Shin S, Kim S, Lim CH, Chung SY, Park YG. Correlation Between the Severity of Multifidus Fatty Degeneration and the Size of Ossification of Posterior Longitudinal Ligament at Each Spinal Level. Neurospine 2023; 20:921-930. [PMID: 37798986 PMCID: PMC10562234 DOI: 10.14245/ns.2346506.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between ossification of the posterior longitudinal ligament (OPLL) size and multifidus fatty degeneration (MFD), hypothesizing that larger OPLL sizes are associated with worse MFD. METHODS One hundred four patients with cervical OPLL who underwent surgery were screened. OPLL occupying diameter and area ratios, the severity of MFD using the Goutallier classification, and range of motion (ROM) of cervical flexion-extension (ΔCobb) were measured. Correlation analyses between OPLL size, MFD severity, and ΔCobb were conducted. MFD severity was compared for each OPLL type using one-way analysis of variance. RESULTS The final clinical data from 100 patients were analyzed. The average Goutallier grade of C2-7 significantly correlated with the average OPLL diameter and area occupying ratios, and OPLL involved vertebral level (r = 0.58, p < 0.01; r = 0.40, p < 0.01; r = 0.47, p < 0.01, respectively). The OPLL size at each cervical level significantly correlated with MFD of the same or 1-3 adjacent levels. ΔCobb angle was negatively correlated with the average Goutallier grade (r = -0.31, p < 0.01) and average OPLL occupying diameter and area ratios (r = -0.31, p < 0.01; r = -0.35, p < 0.01, respectively). Patients with continuous OPLL exhibited worse MFD than those with segmental OPLL (p < 0.01). CONCLUSION OPLL size is clinically correlated with MFD and cervical ROM. OPLL at one spinal level affects MFD at the same and 1-3 adjacent spinal levels. The worsening severity of MFD is associated with the longitudinal continuity of OPLL.
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Affiliation(s)
- Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghoon Shin
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chae Hwan Lim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Young Chung
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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9
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Muellner M, Haffer H, Moser M, Amoroso K, Wang Z, Arzani A, Tan ET, Chiapparelli E, Dodo Y, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3290-3299. [PMID: 37378708 DOI: 10.1007/s00586-023-07814-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time. METHODS Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters. RESULTS A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m2 at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSAPPM declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FATPPM increased. In line with this result, the FIPPM increased in both males (29.9%) and females (19.4%). Females had a higher FIPPM and FIPsoas than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSAPsoas and fCSAPsoas in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FIPPM was observed for both sexes. CONCLUSION The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Artine Arzani
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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10
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Matheve T, Hodges P, Danneels L. The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med 2023; 12:5510. [PMID: 37685576 PMCID: PMC10487902 DOI: 10.3390/jcm12175510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3500 Diepenbeek, Belgium
| | - Paul Hodges
- NHMRC—Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
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11
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Kang M, Kim SH, Jo M, Jung HE, Bae J, Kim HJ. Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1118. [PMID: 37374322 DOI: 10.3390/medicina59061118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.
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Affiliation(s)
- Misun Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyun Eom Jung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jungbin Bae
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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12
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Gao X, Du J, Hao D, He B, Yan L. Risk factors for residual back pain following percutaneous vertebral augmentation: the importance of paraspinal muscle fatty degeneration. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05809-7. [PMID: 37074374 PMCID: PMC10266997 DOI: 10.1007/s00264-023-05809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Residual back pain (RBP) after percutaneous vertebral augmentation (PVA) still exists considerable, and it even affects daily life due to moderate or severe back pain. A variety of risk factors have been previously identified for developing residual back pain. However, there are conflicting reports regarding the association between sarcopenia and residual back pain. As such, the aim of this study was to investigate whether paraspinal muscle fatty degeneration is a predictor of residual back pain. METHODS We retrospectively reviewed the medical records of patients with single-segment OVCF who underwent PVA from January 2016 to January 2022. Patients were divided into RBP group (86 patients) and control group (790 patients) according to whether the visual analog scale (VAS) score ≥ 4. The clinical and radiological data were analyzed. Paraspinal musculature fatty degeneration was measured using the Goutallier classification system (GCS) at the L4 - 5 intervertebral disc level. Univariate and multivariate logistic regression analyses were performed to identify risk factors. RESULTS The results of multivariate logistical regression analysis revealed that posterior fascia injury (odds ratio (OR) = 5.23; 95% confidence interval (CI) 3.12-5.50; P < 0.001), as regards paraspinal muscle fatty degeneration, including Goutallier grading (OR = 12.23; 95% CI 7.81-23.41; P < 0.001), fCSA (OR = 3.06; 95% CI 1.63-6.84; P = 0.002), fCSA/CSA (%) (OR = 14.38; 95% CI 8.80-26.29; P < 0.001), and facet joint violation (OR = 8.54; 95% CI 6.35-15.71; P < 0.001) were identified as independent risk factors for RBP. CONCLUSIONS Posterior fascia injury, paraspinal muscle fatty degeneration, and facet joint violation were identified as independent risk factors for RBP, with paraspinal muscle fatty degeneration playing an important role.
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Affiliation(s)
- Xiangcheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China
- Yan'an University, Yan'an City, Shaanxi Province, China
| | - Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China.
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China.
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13
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Chen X, Li Y, Wang W, Cui P, Wang Y, Lu S. Correlation between inflammatory cytokine expression in paraspinal tissues and severity of disc degeneration in individuals with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:193. [PMID: 36918849 PMCID: PMC10012494 DOI: 10.1186/s12891-023-06295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE Previous animal studies have discovered dysregulation of the local inflammatory state as a novel mechanism to explain structural changes in paraspinal muscles in association with disc degeneration. This study aimed to determine whether the expression of inflammatory genes in the multifidus muscle (MM) differs between individuals with disc degeneration and non-degeneration, which may cause changes in the cross-sectional area (CSA) of paraspinal muscles and clinical outcomes. METHODS Muscles were procured from 60 individuals undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation (LDH). Total and functional CSAs and fatty degeneration of paraspinal muscles on ipsilateral and unilateral sides were measured. Gene expression was quantified using qPCR assays. Paired t-test and Pearson's correlation analysis were used to compare the mean difference and associations, respectively. RESULTS There were significant differences in total CSAs of paraspinal muscles and functional CSA and fatty degeneration of MM between ipsilateral and unilateral sides. Participants in the disc degeneration group displayed higher fat infiltration in MM. The expression of TNF was moderately correlated with total CSAs of paraspinal muscles and functional CSA and fatty degeneration of MM. The expression of IL-1β was strongly correlated with the total and functional CSA of MM. The expression of TGF-β1 was moderately correlated with the functional CSA of MM. The expression of TNF, IL-1β, and TGF-β1 was moderate to strongly correlated with clinical outcomes. CONCLUSION The results show that there were differences in the characteristics of paraspinal muscles between the ipsilateral and unilateral sides, which were affected by disc degeneration and the degree of fat infiltration. High-fat filtration and reduction of CSA of MM are associated with inflammatory dysfunction. There was evidence of a dysregulated inflammatory profile in MM in individuals with poor clinical outcomes.
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Affiliation(s)
- Xiaolong Chen
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China.
| | - Yongjin Li
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Peng Cui
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Yu Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China.
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14
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Diallo TD, Rospleszcz S, Fabian J, Walter SS, Maurer E, Storz C, Roemer F, Rathmann W, Peters A, Jungmann PM, Jung M, Bamberg F, Kiefer LS. Associations of myosteatosis with disc degeneration: A 3T magnetic resonance imaging study in individuals with impaired glycaemia. J Cachexia Sarcopenia Muscle 2023. [PMID: 36892104 DOI: 10.1002/jcsm.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/11/2022] [Accepted: 01/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IVDD) may be linked to dysregulations of skeletal muscle glucose metabolism and fatty alterations of muscle composition (Myosteatosis). Our aim was to evaluate the different associations of magnetic resonance imaging (MRI)-based paravertebral myosteatosis with lumbar disc degeneration in individuals with impaired glucose metabolism and normoglycaemic controls. METHODS In total, 304 individuals (mean age: 56.3 ± 9.1 years, 53.6% male sex, mean body mass index [BMI]: 27.6 ± 4.7 kg/m2 ) from a population-based cohort study who underwent 3-Tesla whole-body chemical-shift-encoded (six echo times) and T2-weighted single-shot-fast-spin-echo MRI were included. Lumbar disc degeneration was assessed at motion segments L1 to L5, categorized according to the Pfirrmann score and defined as Pfirrmann grade > 2 and/or disc bulging/herniation on at least one segment. Fat content of the autochthonous back muscles and the quadratus lumborum muscle was quantified as proton density fat fraction (PDFFmuscle ). Logistic regression models adjusted for age, sex, BMI and regular physical activity were calculated to evaluate the association between PDFFmuscle and outcome IVDD. RESULTS The overall prevalence of IVDD was 79.6%. There was no significant difference in the prevalence or severity distribution of IVDD between participants with or without impaired glucose metabolism (77.7% vs. 80.7%, P = 0.63 and P = 0.71, respectively). PDFFmuscle was significantly and positively associated with an increased risk for the presence of IVDD in participants with impaired glycaemia when adjusted for age, sex and BMI (PDFFautochthonous back muscles : odds ratio [OR] 2.16, 95% confidence interval [CI] [1.09, 4.3], P = 0.03; PDFFquadratus lumborum : OR 2.01, 95% CI [1.04, 3.85], P = 0.04). After further adjustment for regular physical activity, the results attenuated, albeit approaching statistical significance (PDFFautochthonous back muscles : OR 1.97, 95% CI [0.97, 3.99], P = 0.06; PDFFquadratus lumborum : OR 1.86, 95% CI [0.92, 3.76], P = 0.09). No significant associations were shown in healthy controls (PDFFautochthonous back muscles : OR 0.62, 95% CI [0.34, 1.14], P = 0.13; PDFFquadratus lumborum : OR 1.06, 95% CI [0.6, 1.89], P = 0.83). CONCLUSIONS Paravertebral myosteatosis is positively associated with intervertebral disc disease in individuals with impaired glucose metabolism, independent of age, sex and BMI. Regular physical activity may confound these associations. Longitudinal studies will help to better understand the pathophysiological role of skeletal muscle in those with concomitant disturbed glucose haemostasis and intervertebral disc disease, as well as possible underlying causal relationships.
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Affiliation(s)
- Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Munich, Germany
| | - Jana Fabian
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sven S Walter
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Corinna Storz
- Department of Neuroradiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
| | - Annette Peters
- Department of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Munich, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena S Kiefer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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15
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Feng P, Che Y, Gao C, Zhu L, Gao J, Vo NV. Immune exposure: how macrophages interact with the nucleus pulposus. Front Immunol 2023; 14:1155746. [PMID: 37122738 PMCID: PMC10140429 DOI: 10.3389/fimmu.2023.1155746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Intervertebral disc degeneration (IDD) is a primary contributor to low back pain. Immune cells play an extremely important role in modulating the progression of IDD by interacting with disc nucleus pulposus (NP) cells and extracellular matrix (ECM). Encased within the annulus fibrosus, healthy NP is an avascular and immune-privileged tissue that does not normally interact with macrophages. However, under pathological conditions in which neovascularization is established in the damaged disc, NP establishes extensive crosstalk with macrophages, leading to different outcomes depending on the different microenvironmental stimuli. M1 macrophages are a class of immune cells that are predominantly pro-inflammatory and promote inflammation and ECM degradation in the NP, creating a vicious cycle of matrix catabolism that drives IDD. In contrast, NP cells interacting with M2 macrophages promote disc tissue ECM remodeling and repair as M2 macrophages are primarily involved in anti-inflammatory cellular responses. Hence, depending on the crosstalk between NP and the type of immune cells (M1 vs. M2), the overall effects on IDD could be detrimental or regenerative. Drug or surgical treatment of IDD can modulate this crosstalk and hence the different treatment outcomes. This review comprehensively summarizes the interaction between macrophages and NP, aiming to highlight the important role of immunology in disc degeneration.
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Affiliation(s)
- Peng Feng
- School of Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Che
- School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunyu Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghua Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
| | - Nam V. Vo
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
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16
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Gerdle B, Dahlqvist Leinhard O, Lund E, Bengtsson A, Lundberg P, Ghafouri B, Forsgren MF. Fibromyalgia: Associations Between Fat Infiltration, Physical Capacity, and Clinical Variables. J Pain Res 2022; 15:2517-2535. [PMID: 36061487 PMCID: PMC9434492 DOI: 10.2147/jpr.s376590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Obesity is a risk factor for the development of fibromyalgia (FM) and generally most studies report increased Body Mass Index (BMI) in FM. Obesity in FM is associated with a worse clinical presentation. FM patients have low physical conditioning and obesity further exacerbates these aspects. Hitherto studies of FM have focused upon a surrogate for overall measure of fat content, ie, BMI. This study is motivated by that ectopic fat and adipose tissues are rarely investigated in FM including their relationships to physical capacity variables. Moreover, their relationships to clinical variables including are not known. Aims were to 1) compare body composition between FM and healthy controls and 2) investigate if significant associations exist between body composition and physical capacity aspects and important clinical variables. Methods FM patients (n = 32) and healthy controls (CON; n = 30) underwent a clinical examination that included pressure pain thresholds and physical tests. They completed a health questionnaire and participated in whole-body magnetic resonance imaging (MRI) to determine body composition aspects. Results Abdominal adipose tissues, muscle fat, and BMI were significantly higher in FM, whereas muscle volumes of quadriceps were smaller. Physical capacity variables correlated negatively with body composition variables in FM. Both body composition and physical capacity variables were significant regressors of group belonging; the physical capacity variables alone showed stronger relationships with group membership. A mix of body composition variables and physical capacity variables were significant regressors of pain intensity and impact in FM. Body composition variables were the strongest regressors of blood pressures, which were increased in FM. Conclusion Obesity has a negative influence on FM symptomatology and increases the risk for other serious conditions. Hence, obesity, dietary habits, and physical activity should be considered when developing clinical management plans for patients with FM.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping, SE 581 83, Sweden
- Correspondence: Björn Gerdle, Tel +46763927191, Email
| | - Olof Dahlqvist Leinhard
- Centre for Medical Image Science and Visualization (CMIV), Linköping, SE 581 83, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
- AMRA Medical AB, Linköping, Sweden
| | - Eva Lund
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
| | - Ann Bengtsson
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
| | - Peter Lundberg
- Centre for Medical Image Science and Visualization (CMIV), Linköping, SE 581 83, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
| | - Mikael Fredrik Forsgren
- Centre for Medical Image Science and Visualization (CMIV), Linköping, SE 581 83, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE 581 83, Sweden
- AMRA Medical AB, Linköping, Sweden
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Huang R, Yang H, Chen L, Su S, Wu X, Zhuang R, Liu Y. T2 mapping and fat quantification of lumbar paraspinal muscle in ankylosing spondylitis: a case control study. BMC Musculoskelet Disord 2022; 23:614. [PMID: 35761300 PMCID: PMC9235229 DOI: 10.1186/s12891-022-05570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To compare changes in the composition of paraspinal muscles of patients with ankylosing spondylitis (AS) and matched healthy controls using T2 mapping and T2 IDEAL and correlate the quantitative magnetic resonance imaging (qMRI) results with clinical assessments of AS patients. METHOD In total, 37 AS patients and 37 healthy controls were enrolled in the case control study. T2 mapping with and without fat saturation and IDEAL imaging were used to assess the multifidus (MF) and erector spinae (ES) at the levels of L3/L4 and L4/L5 for all subjects. Mean T2non-fatsat, T2fat, T2fatsat, cross-sectional area (CSA), and fat fraction (FF) were compared between AS and healthy controls. Correlations of qMRI results with clinical assessments were analyzed in AS. RESULTS Significantly elevated mean T2non-fatsat values and the FF of the MF and ES at both levels were observed in AS and compared to the controls (p < 0.05). The mean T2fatsat values of ES and MF were significantly higher only at the level of L3/L4 in AS compared to healthy controls (p < 0.05). A loss of muscle CSA compatible with atrophy was present in MF and ES at both levels in AS compared to the controls (p < 0.05). Weak to moderate positive correlations were found between FF and age and disease duration in AS (r = 0.318-0.415, p < 0.05). However, such positive correlation was not observed between FF and disease duration after adjusting for age (p > 0.05). CONCLUSIONS Our findings indicate that using a combination of IDEAL and T2 mapping may provide deeper insights into the pathophysiological degeneration of paraspinal muscles in AS.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Hongwu Yang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Liujiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Xiaojia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
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Kim HJ, Rho M, Yoon KB, Jo M, Lee DW, Kim SH. Influence of cross-sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients. Pain Pract 2022; 22:621-630. [PMID: 35735193 DOI: 10.1111/papr.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection. METHODS Patients ≥65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcomes after injection were identified using multivariate analysis. RESULTS A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis. Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8% vs. 42.7%, p < 0.001), and this result was predominantly observed in female patients. However, there was no difference in the muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm2 /m2 , p = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, p < 0.001). Multivariate logistic regression analysis revealed that preinjection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084-3.422, p = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371-5.965, p = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805-10.043, p = 0.001) were significantly associated with poor analgesia after injection. CONCLUSION High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, the cross-sectional area of the paraspinal muscles was not associated with pain relief after injection.
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Affiliation(s)
- Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Miribi Rho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Correlation between the fatty infiltration of paraspinal muscles and disc degeneration and the underlying mechanism. BMC Musculoskelet Disord 2022; 23:509. [PMID: 35637476 PMCID: PMC9150320 DOI: 10.1186/s12891-022-05466-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Low back pain (LBP) is associated with lumbar disc degeneration (LDD) and fatty infiltration of paraspinal muscles. However, there are some controversies about the relationship between LDD and fatty infiltration of paraspinal muscles, and the causation of them is also not clear. Thus, we investigated whether the degree of LDD was associated with fatty infiltration of paraspinal muscles and preliminarily explored the underlying mechanism. Methods A retrospective study was conducted on 109 patients with chronic LBP. The degree of LDD was assessed by the Pfirrmann classification. Total muscle cross-sectional area, L4 vertebral body endplate area, and fat cross-sectional area at axial T2-weighted MRI were measured. Multifidus and lumbar disc specimens were taken from eight individuals undergoing discectomy for disc herniation. Gene and protein expression levels of TNF were quantified through qPCR assays and ELISA, respectively. Results The relative cross-sectional area, total muscle cross-sectional area, and muscle cross-sectional area asymmetry were not related to LDD. Pfirrmann grades correlated strongly with fatty infiltration of the multifidus and moderately with fatty infiltration of the erector spinae and the psoas muscles. Linear regression analysis suggested that Pfirrmann grades were most associated with fatty infiltration of the multifidus. Compared with II-degree degeneration discs (mild-degeneration group), fatty infiltration of the multifidus in IV-degree degeneration discs (severe-degeneration group) significantly increased, accompanied by increased mRNA expression of TNF. Meanwhile, the protein expression levels of TNF (pg/g protein) in discs (16.62 ± 4.33) and multifidus (13.10 ± 2.76) of the severe-degeneration group were higher than those in the mild-degeneration group (disc: 9.75 ± 2.18; multifidus: 7.84 ± 2.43). However, the mRNA expression of TNF in the multifidus was not significantly different between the two groups. Conclusions The results suggest that LDD is associated with fatty infiltration of the multifidus. The possible underlying mechanism is that LDD induces fatty infiltration by inflammation. Furthermore, compared with the erector spinae and the psoas muscles, fatty infiltration of the multifidus shows an optimal correlation with LDD, which may contribute to further understanding of LDD pathology. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05466-8.
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20
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The relationships between physical activity, lumbar multifidus muscle morphology, and low back pain from childhood to early adulthood: a 12-year longitudinal study. Sci Rep 2022; 12:8851. [PMID: 35614086 PMCID: PMC9132932 DOI: 10.1038/s41598-022-12674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
We investigated the longitudinal associations between physical activity (PA), lumbar multifidus morphology, and impactful low back pain (LBP) in young people. Nine-year-old children were recruited from 25 primary schools and followed up at age 13, 16, and 21 years. We measured PA with accelerometers at age 9, 13, and 16; quantified patterns of lumbar multifidus intramuscular adipose tissue (IMAT) change from 13 to 16 years using magnetic resonance imaging; and recorded LBP and its impact with standardised questionnaires and interviews. Associations were examined with crude and adjusted logistic or multinomial models and reported with odds ratios (OR) or relative risk ratios (RRR). We included data from 364 children (mean[SD] age = 9.7[.4] years). PA behaviour was not associated with LBP. Having persistently high IMAT levels at age 13 and 16 was associated with greater odds of LBP (OR[95% CI] = 2.98[1.17 to 7.58]). Increased time in moderate and vigorous intensity PA was associated with a lower risk of higher IMAT patterns (RRR[95% CI] = .67[.46 to .96] to .74[.55 to 1.00]). All associations became non-significant after adjusting for sex and body mass index (BMI). Future studies investigating the relationships between PA behaviour, lumbar multifidus IMAT, and impactful LBP should account for potential confounding by sex and BMI.
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21
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Yan M, Song Z, Kou H, Shang G, Shang C, Chen X, Ji Y, Bao D, Cheng T, Li J, Lv X, Liu H, Chen S. New Progress in Basic Research of Macrophages in the Pathogenesis and Treatment of Low Back Pain. Front Cell Dev Biol 2022; 10:866857. [PMID: 35669508 PMCID: PMC9163565 DOI: 10.3389/fcell.2022.866857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Low back pain (LBP) is quite common in clinical practice, which can lead to long-term bed rest or even disability. It is a worldwide health problem remains to be solved. LBP can be induced or exacerbated by abnormal structure and function of spinal tissue such as intervertebral disc (IVD), dorsal root ganglion (DRG) and muscle; IVD degeneration (IVDD) is considered as the most important among all the pathogenic factors. Inflammation, immune response, mechanical load, and hypoxia etc., can induce LBP by affecting the spinal tissue, among which inflammation and immune response are the key link. Inflammation and immune response play a double-edged sword role in LBP. As the main phagocytic cells in the body, macrophages are closely related to body homeostasis and various diseases. Recent studies have shown that macrophages are the only inflammatory cells that can penetrate the closed nucleus pulposus, expressed in various structures of the IVD, and the number is positively correlated with the degree of IVDD. Moreover, macrophages play a phagocytosis role or regulate the metabolism of DRG and muscle tissues through neuro-immune mechanism, while the imbalance of macrophages polarization will lead to more inflammatory factors to chemotaxis and aggregation, forming an “inflammatory waterfall” effect similar to “positive feedback,” which greatly aggravates LBP. Regulation of macrophages migration and polarization, inhibition of inflammation and continuous activation of immune response by molecular biological technology can markedly improve the inflammatory microenvironment, and thus effectively prevent and treat LBP. Studies on macrophages and LBP were mainly focused in the last 3–5 years, attracting more and more scholars’ attention. This paper summarizes the new research progress of macrophages in the pathogenesis and treatment of LBP, aiming to provide an important clinical prevention and treatment strategy for LBP.
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Affiliation(s)
- Miaoheng Yan
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zongmian Song
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Kou
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guowei Shang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunfeng Shang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangrong Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanhui Ji
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Deming Bao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian Cheng
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinfeng Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Lv
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjian Liu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Songfeng Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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22
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The association between changes in multifidus muscle morphology and back pain scores following discectomy surgery for lumbar disc herniation: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1784-1794. [PMID: 35325300 DOI: 10.1007/s00586-022-07181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the impact of discectomy on back muscles (e.g. multifidus muscle (MM)) morphology in patients with lumbar disc herniation (LDH) following discectomy surgery, address the association of back muscles morphology with pain score preoperatively and post-operatively, and investigate the relationships between the changes from pre- to post-operative back muscles measurements and pain score (primary outcome) and disability score (secondary outcome) change following discectomy if any. METHODS We searched three online databases for randomized controlled trials (RCTs) and observational studies. In LDH patients, eligible for discectomy surgery, pre- and post-operative and the changes from pre- to post-operative of back and/or leg pain with Visual Analogue Scale (VAS) and multifidus muscle morphology, were considered as primary outcomes. Cochrane Risk-of-Bias 2 tool and Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality of RCTs and observational studies, respectively. Standardize mean difference (SMD) with 95% confidence intervals (CI) was evaluated. A meta-regression analysis was conducted. GRADE approach was used to summarize the strength of evidence. RESULTS One RCT and five observational studies were included in the analysis of 489 patients with LDH undergoing discectomy surgery. The mean overall follow-up was 64.9 weeks (6 to 148.7 weeks). There was a significant negative relationship between the change from pre- to post-operative cross-sectional area (CSA) in MM and change in VAS back pain [regression coefficient = -0.01, (95% CI = -0.02, -0.01), p = 0.044] after discectomy surgery. No significant relationship between preoperative CSA in MM and preoperative/post-operative clinical (any of the follow-up periods) scores could be established. CONCLUSION The results of this study found very low-quality grade evidence for an association between higher reduction of CSA in MM and less reductions of back pain scores following discectomy surgery for patients with LDH. Due to the heterogeneity and methodological limitations, further studies will improve understanding and aid preoperative counselling.
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Abedpoor N, Taghian F, Hajibabaie F. Physical activity ameliorates the function of organs via adipose tissue in metabolic diseases. Acta Histochem 2022; 124:151844. [PMID: 35045377 DOI: 10.1016/j.acthis.2022.151844] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
Adipose tissue is a dynamic organ in the endocrine system that can connect organs by secreting molecules and bioactive. Hence, adipose tissue really plays a pivotal role in regulating metabolism, inflammation, energy homeostasis, and thermogenesis. Disruption of hub bioactive molecules secretion such as adipokines leads to dysregulate metabolic communication between adipose tissue and other organs in non-communicable disorders. Moreover, a sedentary lifestyle may be a risk factor for adipose tissue function. Physical inactivity leads to fat tissue accumulation and promotes obesity, Type 2 diabetes, cardiovascular disease, neurodegenerative disease, fatty liver, osteoporosis, and inflammatory bowel disease. On the other hand, physical activity may ameliorate and protect the body against metabolic disorders, triggering thermogenesis, metabolism, mitochondrial biogenesis, β-oxidation, and glucose uptake. Furthermore, physical activity provides an inter-organ association and cross-talk between different tissues by improving adipose tissue function, reprogramming gene expression, modulating molecules and bioactive factors. Also, physical activity decreases chronic inflammation, oxidative stress and improves metabolic features in adipose tissue. The current review focuses on the beneficial effect of physical activity on the cardiovascular, locomotor, digestive, and nervous systems. In addition, we visualize protein-protein interactions networks between hub proteins involved in dysregulating metabolic induced by adipose tissue.
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Affiliation(s)
- Navid Abedpoor
- Department of Sports Physiology, Faculty of Sports Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Farzaneh Taghian
- Department of Sports Physiology, Faculty of Sports Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Fatemeh Hajibabaie
- Department of Physiology, Medicinal Plants Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
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Huang Y, Wang L, Zeng X, Chen J, Zhang Z, Jiang Y, Nie L, Cheng X, He B. Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain. Front Endocrinol (Lausanne) 2022; 13:792819. [PMID: 35721738 PMCID: PMC9204273 DOI: 10.3389/fendo.2022.792819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
There is an interaction between the lumbar spine and paraspinal muscles, which may play a role in the development of intervertebral disc (IVD) degeneration and may affect CLBP. The study aims to assess the relationship between IVD degeneration and paraspinal muscle fat infiltration in CLBP patients by quantitative MR imaging, and to evaluate the influence of sex and age on CLBP muscle fat infiltration. Sixty CLBP patients (46.3 years ±17.0) and thirty-two healthy subjects (44.9 years ±17.6) were recruited for this study. 3.0 T MRI was used to perform the sagittal and axial T1, T2 of the lumbar spine, and axial paraspinal muscle IDEAL imaging at the L4/5 and L5/S1 levels. Proton density fat fraction (PDFF) of the multifidus and erector spinae at two IVD levels were measured. The Pfirrmann grades of IVD degeneration, Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) were also evaluated. Compare the cross-sectional area (CSA) and PDFF of the paraspinal muscles between CLBP patients and healthy subjects, and analyze the relationship between the muscle PDFF and Pfirrmann grades, gender, and age of CLBP patients. Compared with healthy subjects, the CSA of the multifidus muscle in CLBP patients decreased (1320.2±188.1mm2vs. 1228.7±191.0 mm2, p<0.05) at the L4/5 level, the average PDFF increased, (7.7±2.6% vs. 14.79±5.3%, 8.8±4.2% vs. 16.03±5.3%, all p<0.05) at both L4/5 and L5/S1 levels. The PDFF of paraspinal muscles were correlated with adjacent IVD degeneration, ODI and VSA in CLBP patients (all p<0.05). After using age and body mass index (BMI) as control variables, significance was retained (all p<0.05). Multiple regression analysis revealed sex and age also were significantly associated with multifidus PDFF (all p < 0.05). This study confirmed that the CSA decreased and the PDFF increased of the paraspinal muscles in CLBP patients. It reveals a significant correlation between the PDFF of CLBP paraspinal muscles and the grade of IVD degeneration. Sex and age are also important factors influencing CLBP paraspinal muscle infiltration.
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Affiliation(s)
- Yilong Huang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaomin Zeng
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- GE Healthcare, Magnetic Resonance Field Application Team, Chengdu, China
| | - Jiaxin Chen
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenguang Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuanming Jiang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lisha Nie
- GE Healthcare, Magnetic Resonance Research China, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
| | - Bo He
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Bo He, ; Xiaoguang Cheng,
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Wang Z, Zhao Z, Han S, Hu X, Ye L, Li Y, Gao J. Advances in research on fat infiltration and lumbar intervertebral disc degeneration. Front Endocrinol (Lausanne) 2022; 13:1067373. [PMID: 36568091 PMCID: PMC9768030 DOI: 10.3389/fendo.2022.1067373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Low back pain (LBP) is a disabling condition with no available cure, severely affecting patients' quality of life. Intervertebral disc degeneration (IVDD) is the leading cause of chronic low back pain (CLBP). IVDD is a common and recurrent condition in spine surgery. Disc degeneration is closely associated with intervertebral disc inflammation. The intervertebral disc is an avascular tissue in the human body. Transitioning from hematopoietic bone marrow to bone marrow fat may initiate an inflammatory response as we age, resulting in bone marrow lesions in vertebrae. In addition, the development of LBP is closely associated with spinal stability imbalance. An excellent functional state of paraspinal muscles (PSMs) plays a vital role in maintaining spinal stability. Studies have shown that the diminished function of PSMs is mainly associated with increased fat content, but whether the fat content of PSMs is related to the degree of disc degeneration is still under study. Given the vital role of PSMs lesions in CLBP, it is crucial to elucidate the interaction between PSMs changes and CLBP. Therefore, this article reviews the advances in the relationship and the underlying mechanisms between IVDD and PSMs fatty infiltration in patients with CLBP.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijun Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianghui Hu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liguo Ye
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yongning Li, ; Jun Gao,
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Yongning Li, ; Jun Gao,
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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27
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Yamamoto S, Malakoutian M, Theret M, Street J, Rossi F, Brown SHM, Saito M, Oxland TR. The Effect of Posterior Lumbar Spinal Surgery on Biomechanical Properties of Rat Paraspinal Muscles 13 Weeks After Surgery. Spine (Phila Pa 1976) 2021; 46:E1125-E1135. [PMID: 34156788 DOI: 10.1097/brs.0000000000004036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Preclinical study in rodents. OBJECTIVE To investigate changes in biomechanical properties of paraspinal muscles following a posterior spinal surgery in an animal model. SUMMARY OF BACKGROUND DATA Posterior spine surgery damages paraspinal musculature per histological and imaging studies. The biomechanical effects of these changes are unknown. METHODS 12 Sprague-Dawley rats were divided equally into sham and surgical injury (SI) groups. For sham, the skin and lumbodorsal fascia were incised at midline. For SI, the paraspinal muscles were detached from the vertebrae, per normal procedure. Thirteen weeks postsurgery, multifidus and longissimus biopsies at L1, L3, and L5 levels were harvested on the right. From each biopsy, three fibers and three to six bundles of fibers (∼10-20 fibers ensheathed in their extracellular matrix) were tested mechanically to measure their passive elastic modulus. The collagen content and fatty infiltration of each biopsy were also examined histologically by immunofluorescence staining. Nonparametric statistical methods were used with a 1.25% level of significance. RESULTS A total of 220 fibers and 279 bundles of fibers were tested. The elastic moduli of the multifidus and longissimus fibers and longissimus fiber bundles were not significantly different between the SI and sham groups. However, the elastic modulus of multifidus fiber bundles was significantly greater in the SI group compared to sham (SI median 82 kPa, range 23-284; sham median 38 kPa, range 23-50, P = 0.0004). The elastic modulus of multifidus fiber bundles in the SI group was not statistically different between spinal levels (P = 0.023). For histology, only collagen I deposition in multifidus was significantly greater in the SI group (median 20.8% vs. 5.8% for sham, P < 0.0001). CONCLUSION The surgical injury increased the passive stiffness of the multifidus fiber bundles. Increased collagen content in the extracellular matrix is the likely reason and these changes may be important in the postoperative compensation of the spine.Level of Evidence: N/A.
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Affiliation(s)
- Shun Yamamoto
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, Canada
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masoud Malakoutian
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, Canada
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada
| | - Marine Theret
- School of Biomedical Engineering, The University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, Canada
| | - John Street
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, Canada
| | - Fabio Rossi
- School of Biomedical Engineering, The University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Thomas R Oxland
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, Canada
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada
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Noonan AM, Brown SHM. Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR Spine 2021; 4:e1171. [PMID: 34611593 PMCID: PMC8479522 DOI: 10.1002/jsp2.1171] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/17/2021] [Accepted: 08/21/2021] [Indexed: 12/18/2022] Open
Abstract
Low back pain disorders affect more than 80% of adults in their lifetime and are the leading cause of global disability. The muscles attaching to the spine (ie, paraspinal muscles) are critical for proper spine health and play a crucial role in the functioning of the spine and whole body; however, reports of muscle dysfunction and insufficiency in chronic LBP (CLBP) patients are common. This article presents a review of the current understanding of the relationship between paraspinal muscle pathophysiology and spine-related disorders. Human literature demonstrates a clear association between altered muscle structure/function, most notably fatty infiltration and fibrosis, and low back pain disorders; other associations, including muscle cell atrophy and fiber type changes, are less clear. Animal literature then provides some mechanistic insight into the complex relationships, including initiating factors and time courses, between the spine and spine muscles under pathological conditions. It is apparent that spine pathology can directly lead to changes in the paraspinal muscle structure, function, and biology. It also appears that changes to the muscle structure and function can directly lead to changes in the spine (eg, deformity); however, this relationship is less well studied. Future work must focus on providing insight into possible mechanisms that regulate spine and paraspinal muscle health, as well as probing how muscle degeneration/dysfunction might be an initiating factor in the progression of spine pathology.
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Affiliation(s)
- Alex M. Noonan
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphOntarioCanada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphOntarioCanada
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Mitchell B, Deckers K, De Smedt K, Russo M, Georgius P, Green M, Gulve A, van Buyten JP, Smet I, Mehta V, Baranidharan G, Rathmell J, Gilligan C, Goss B, Eldabe S. Durability of the Therapeutic Effect of Restorative Neurostimulation for Refractory Chronic Low Back Pain. Neuromodulation 2021; 24:1024-1032. [PMID: 34242440 PMCID: PMC8456956 DOI: 10.1111/ner.13477] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 01/23/2023]
Abstract
Objectives The purpose of the ongoing follow‐up of ReActiv8‐A clinical trial is to document the longitudinal benefits of episodic stimulation of the dorsal ramus medial branch and consequent contraction of the lumbar multifidus in patients with refractory mechanical chronic low back pain (CLBP). We report the four‐year outcomes of this trial. Materials and Methods ReActiv8‐A is a prospective, single‐arm trial performed at nine sites in the United Kingdom, Belgium, and Australia. Eligible patients had disabling CLBP (low back pain Numeric Rating Scale [NRS] ≥6; Oswestry Disability Index [ODI] ≥25), no indications for spine surgery or spinal cord stimulation, and failed conventional management including at least physical therapy and medications for low back pain. Fourteen days postimplantation, stimulation parameters were programmed to elicit strong, smooth contractions of the multifidus, and participants were given instructions to activate the device for 30‐min stimulation‐sessions twice daily. Annual follow‐up through four years included collection of NRS, ODI, and European Quality of Life Score on Five Dimensions (EQ‐5D). Background on mechanisms, trial design, and one‐year outcomes were previously described. Results At baseline (N = 53) (mean ± SD) age was 44 ± 10 years; duration of back pain was 14 ± 11 years, NRS was 6.8 ± 0.8, ODI 44.9 ± 10.1, and EQ‐5D 0.434 ± 0.185. Mean improvements from baseline were statistically significant (p < 0.001) and clinically meaningful for all follow‐ups. Patients completing year 4 follow‐up, reported mean (±standard error of the mean) NRS: 3.2 ± 0.4, ODI: 23.0 ± 3.2, and EQ‐5D: 0.721 ± 0.035. Moreover, 73% of participants had a clinically meaningful improvement of ≥2 points on NRS, 76% of ≥10 points on ODI, and 62.5% had a clinically meaningful improvement in both NRS and ODI and 97% were (very) satisfied with treatment. Conclusions In participants with disabling intractable CLBP who receive long‐term restorative neurostimulation, treatment satisfaction remains high and improvements in pain, disability, and quality‐of‐life are clinically meaningful and durable through four years.
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Affiliation(s)
- Bruce Mitchell
- Monash Clinical Research Pty Ltd, Clayton, VIC, Australia
| | | | | | - Marc Russo
- Hunter Pain Clinic, Broadmeadow, NSW, Australia
| | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, QLD, Australia
| | - Matthew Green
- Pain Medicine of South Australia, Welland, SA, Australia
| | - Ashish Gulve
- The James Cook University Hospital, Middlesbrough, UK
| | | | - Iris Smet
- Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium
| | | | | | - James Rathmell
- Brigham and Women's Healthcare, Harvard Medical School, Boston, MA, USA
| | - Chris Gilligan
- Brigham and Women's Healthcare, Harvard Medical School, Boston, MA, USA
| | - Ben Goss
- Mainstay Medical BV, Amsterdam, The Netherlands
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
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Research Progress on the Mechanism of Lumbarmultifidus Injury and Degeneration. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6629037. [PMID: 33728023 PMCID: PMC7936897 DOI: 10.1155/2021/6629037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 01/15/2023]
Abstract
This review summarizes recent research progress in the clinical features, image manifestations, and pathological mechanism of multifidus injury. After a brief introduction to the fiber classification, innervation, blood supply, and multifidus function, some factors of multifidus injury, consisting of denervation, intraoperative incision selection and traction, and lumbar degenerative disease are overviewed. In addition, the clinical index of multifidus injury including myoglobin, creatine kinase, IL-6, C-reactive protein, the cross-sectional area of multifidus, the degree of fat infiltration, and intraoperative biopsy are summarized. Furthermore, we recommend that patients with chronic low back pain should take the long-term exercise of lumbodorsal muscles. Finally, some remaining issues, including external fixation and the imaging quantitative evaluation criteria of multifidus, need to be further explored in the future.
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The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy. Rheumatol Int 2021; 41:595-603. [PMID: 33502552 DOI: 10.1007/s00296-020-04781-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Paravertebral muscles are affected in spondyloarthritis. Decreased mobility of spine may lead to atrophy and fatty degeneration of these muscles. The objective of this study was to compare the sonographic, electrophysiological and magnetic resonance imaging (MRI) features of paraspinal muscles between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The patients who were diagnosed as AS with modified New York criteria and those as nr-axSpA with ASAS 2009 criteria were enrolled. Clinical evaluation, electrophysiological examination including nerve conduction studies and needle electromyography (EMG) for lower extremities and paraspinal mapping (PSM) were performed by the first examiner. The second examiner measured lumbar multifidus areas, graded the fatty degeneration of the muscle at different levels in T2 weighted axial MRI and also performed the ultrasonographic evaluation. A total of 19 patients with AS and 14 patients with nr-axSpA were evaluated. MRI of 2 patients with AS could not be obtained. Right lumbar multifidus area/vertebra area (MV ratio) was smaller in AS patients at L3 level (p 0,029); there were no significant differences in other levels. Fatty degeneration was also higher in AS patients in left multifidus at L5-S1 disc level (p 0,015). PSM scores that demonstrate the extent of denervation in paraspinal muscles were significantly higher in AS patients than in nr-axSpA patients (p < 0,001). Patients with AS have more fatty degeneration and denervation in paraspinal muscles. These processes may also contribute the severity of pain and disability. The relationship between paraspinal muscle denervation and progression of fatty degeneration should further be revealed.
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Intervertebral Disc and Adipokine Leptin-Loves Me, Loves Me Not. Int J Mol Sci 2020; 22:ijms22010375. [PMID: 33396484 PMCID: PMC7795371 DOI: 10.3390/ijms22010375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022] Open
Abstract
Leptin—the most famous adipose tissue-secreted hormone—in the human body is mostly observed in a negative connotation, as the hormone level increases with the accumulation of body fat. Nowadays, fatness is becoming another normal body shape. Fatness is burdened with numerous illnesses—including low back pain and degenerative disease of lumbar intervertebral disc (IVD). IVD degeneration and IVD inflammation are two indiscerptible phenomena. Irrespective of the underlying pathophysiological background (trauma, obesity, nutrient deficiency), the inflammation is crucial in triggering IVD degeneration. Leptin is usually depicted as a proinflammatory adipokine. Many studies aimed at explaining the role of leptin in IVD degeneration, though mostly in in vitro and on animal models, confirmed leptin’s “bad reputation”. However, several studies found that leptin might have protective role in IVD metabolism. This review examines the current literature on the metabolic role of different depots of adipose tissue, with focus on leptin, in pathogenesis of IVD degeneration.
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