Lumbar Multifidus Muscle Morphology Changes in Patient with Different Degrees of Lumbar Disc Herniation: An Ultrasonographic Study

Clinical observation of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation and analysis of influencing factors for recurrence

OBJECTIVE

To investigate the clinical effects of percutaneous transforaminal endoscopic discectomy (PELD) in treating lumbar disc herniation (LDH) and analyze the related factors for postoperative recurrence.

METHODS

A retrospective analysis was conducted on 168 patients with lumbar disc herniation who underwent percutaneous transforaminal endoscopy at the Second Hospital of Tangshan from January 2017 to January 2021. The patients were followed up for 1 year. The Oswestry disability index (ODI) and visual analog scale (VAS) for low back pain/radicular pain were recorded before the operation and at the final follow-up. The patients' overall responses were evaluated according to Stauffer-Coventry's response evaluation criteria. Univariate analysis and multivariate logistic regression were used to analyze the relationship between basic data indicators and postoperative recurrence.

RESULTS

Compared with preoperative values, the postoperative VAS scores and ODI indices were significantly reduced at different time points (both P < 0.05). During the final follow-up, the efficacy was rated as excellent in 55 cases, good in 59 cases, fair in 35 cases, and poor in 19 cases, with an overall excellent and good rate of 67.86%. Among them, 12 patients had postoperative recurrence, with a recurrence rate of 7.14%. Univariate analysis indicated that age ≥ 49 years, BMI ≥ 24.62 kg/m2, partition of disc herniation location, intraoperative annulus fibrosus damage, and incomplete removal of nucleus pulposus during surgery were independent risk factors for postoperative recurrence (all P < 0.05).

CONCLUSION

PELD surgery for LDH can achieve favorable clinical efficacy. However, intraoperative annulus fibrosus injury and incomplete removal of the nucleus pulposus during surgery may lead to secondary recurrence in patients.

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain

Introduction

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness.

Methods

A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA.

Results

Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio.

Conclusion

This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

Effects of the NeuroHAB Program on Low Back Pain and Oswestry Disability Index Scores: A Retrospective Wait-List Control Study

Movement theory and the study of movement dysfunction mark a paradigm shift in the treatment of low back pain symptoms, the majority of which are mechanical in origin at the outset. Treating movement dysfunction centers around unified and consistent rehabilitation that defines proficient movement for the lumbopelvic spine. The purpose of this study is to document the improvement in pain and disability of 290 patients who underwent NeuroHAB Functional Movement Therapy to reverse their lumbopelvic movement dysfunction attributed to causing their back pain symptoms between 2019 and 2023. Oswestry Disability Index (ODI) scores were collected from each participant on three occasions: the first consultation, after a waiting period/pre-intervention, and after the eight-week intervention. A single-factor ANOVA of all three ODI data sets was conducted, along with supporting descriptive statistics. A post-hoc t-test pairwise comparison was conducted for accuracy. The average ODI 1 score (taken at the first consultation) was 15.26 ± 6.1% (CI: 14.3-16.2); ODI 2 (after a waiting period, before NeuroHAB) was 14.71 ± 6.0% (CI: 13.82-15.59); and ODI 3 (post-intervention) was 9.09 ± 8.6% (CI: 8.305-9.875). There was no significant change from ODI 1 to ODI 2 (between the consultation and waitlist control periods). However, a significant reduction between ODI 2 and ODI 3 was observed (pre- and post-intervention) (mean difference: 5.62, p ≤ 0.001), and a 40.41% reduction was observed between ODI 1 (the ODI score taken at the first consultation) and ODI 3 (the ODI score taken after NeuroHAB, post-intervention) (mean difference: 6.17, p ≤ 0.001). A 50% ODI reduction was reported in the "Crippled" category (mean difference 16.15, p ≤ 0.001). The inclusion of functional movement proficiency and stability in future guidelines is a necessary step towards meaningful improvement in epidemic levels of back pain-related clinical and economic morbidity.

Spinal degeneration and lumbar multifidus muscle quality may independently affect clinical outcomes in patients conservatively managed for low back or leg pain

Few non-surgical, longitudinal studies have evaluated the relations between spinal degeneration, lumbar multifidus muscle (LMM) quality, and clinical outcomes. None have assessed the potential mediating role of the LMM between degenerative pathology and 12-month clinical outcomes. This prospective cohort study used baseline and 12-month follow-up data from 569 patients conservatively managed for low back or back-related leg pain to estimate the effects of aggregate degenerative lumbar MRI findings and LMM quality on 12-month low back and leg pain intensity (0-10) and disability (0-23) outcomes, and explored the mediating role of LMM quality between degenerative findings and 12-month clinical outcomes. Adjusted mixed effects generalized linear models separately estimated the effect of aggregate spinal pathology and LMM quality. Mediation models estimated the direct and indirect effects of pathology on leg pain, and pathology and LMM quality on leg pain, respectively. Multivariable analysis identified a leg pain rating change of 0.99 [0.14; 1.84] (unstandardized beta coefficients [95% CI]) in the presence of ≥ 4 pathologies, and a disability rating change of - 0.65 [- 0.14; - 1.16] for each 10% increase in muscle quality, but no effect on back pain intensity. Muscle quality had a non-significant mediating role (13.4%) between pathology and leg pain intensity. The number of different pathologies present demonstrated a small effect on 12-month leg pain intensity outcomes, while higher LMM quality had a direct effect on 12-month disability ratings but no mediating effect between pathology and leg pain. The relations between degenerative pathology, LMM quality, and pain-related outcomes appear complex and may include independent pathways.

Multifidus dysfunction and restorative neurostimulation: a scoping review

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.

The association between morphological characteristics of paraspinal muscle and spinal disorders

BACKGROUND

Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration.

OBJECTIVES

The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research.

METHODS

We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions.

RESULTS

The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice.

CONCLUSION

The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.

Are paraspinal muscle quantity, lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study

INTRODUCTION

The aim of the study was to investigate the relationship between lumbar disc herniation and Goutallier classification (GC), lumbar indentation value, and subcutaneous adipose tissue thickness.

METHODS

102 consecutive patients (59 female and 43 male) with lumbar back pain, numbness, tingling, or pain in the lower extremity indicating radiculopathy who had undergone lumbar magnetic resonance imaging (MRI) and had an intervertebral disc herniation in the L4-5 level, were included in the study. 102 patients who have undergone lumbar MRI in the same time period and have no disc herniation were chosen to be the control group and were selected so as to match the herniated group for sex and age. All these patients' scans were re-interpreted regarding paraspinal muscle atrophy (using the GC), lumbar indentation value, and subcutaneous adipose tissue thickness in the L4-5 level.

RESULTS

The Goutallier score was higher in the herniated group, compared with the non-herniated group (p < 0.001). There was no statistical difference between herniated and non-herniated groups regarding lumbar indentation value (LIV) and subcutaneous adipose tissue thickness (SATT). A Goutallier score of 1.5 provided the highest sensitivity x specificity value to indicate the disc herniation according to the statistical results. The individuals with a Goutallier score of 2, 3, and 4 have 2.87 times more likely to have disc herniation in their MRIs than the ones with a score of 0 and 1.

CONCLUSION

Paraspinal muscle atrophy seems to be related to the presence of disc herniations. The cut-off value of GC to indicate the disc herniation in this study might be useful to predict the risk for disc herniation regarding the Goutallier score. The LIV and SATT measured in magnetic resonance images were randomly distributed between individuals with herniated and non-herniated groups, and statistically, no relationship was observed between these groups regarding these parameters.

IMPLICATIONS FOR PRACTICE

The effect of the parameters studied in this research on disc herniations are expected to be an added value to the literature. The awareness of risk factors for intervertebral disc herniations might be used in preventive medicine to predict the risk and understand the tendency of an individual for disc herniations to occur in the future. Further investigations are needed to establish whether there is a causal relationship or correlation between these parameters and disc herniation.

The Effect of M-Health-Based Core Stability Exercise Combined with Self-Compassion Training for Patients with Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study

INTRODUCTION

Nonspecific chronic low back pain (NCLBP) is a leading contributor to disease burden worldwide, and the management of NCLBP has always been a problem. This study is designed to explore the feasibility and efficacy of m-health-based core stability exercise (CSE) combined with self-compassion training (SCT) and compare it with m-health-based CSE alone for the management of NCLBP.

METHODS

This study is a pilot, patient-blinded randomized controlled trial. Participants with NCLBP were randomized into an intervention group and a control group. All the participants received m-health-based CSE, but those in the intervention group also received SCT before CSE. The intervention took place weekly on Saturday or Sunday for 4 weeks in total. Patients self-assessed their outcomes by filling out electronic questionnaires at 4 and 16 weeks after the start of the study. The primary outcome metrics for these questionnaires were back pain disability (based on the Roland-Morris Disability Questionnaire, RMDQ) and Pain intensity (Numeric Rating Scale, NRS; current pain, worst pain, average pain). The secondary outcome metrics were anxiety (GAD-7,7-item Generalized Anxiety Disorder scale), Depression Symptoms (PHQ-9,Patient Health Questionnaire-9), pain catastrophizing (PCS, Pain Catastrophizing Scale) and Self-efficiency (PSEQ, Pain Self-Efficiency Questionnaire).

RESULTS

A total of 37 patients comprising 28 (75.7%) females completed the study, with 19 patients in the intervention group and 18 in the control group. The mean (SD) patient age was 35.2 (11.1) years. For all primary outcomes, although there were no significant differences between groups, we found that participants in the intervention group improved function and pain earlier. The RMDQ score changed by - 1.771 points (95% CI - 3.768 to 0.227) from baseline to 4 weeks in the control group and by - 4.822 points (95% CI - 6.752 to - 2.892) in the intervention group (difference between groups, - 3.052 [95% CI - 5.836 to - 0.267]). Also, the RMDQ score changed by - 3.328 points (95% CI - 5.252 to - 1.403) from baseline to 16 weeks in the control group and by - 5.124 points (95% CI - 7.014 to - 3.233) in the intervention group (difference between groups - 1.796 [95% CI - 4.501 to 0.909]). A similar pattern was found in the NRS scores. For secondary outcomes, the intervention group was superior to the control group in for GAD-7 (intervention difference from CSE along at week 16, - 2.156 [95% CI - 4.434 to - 0.122; P value for group effect was 0.030]). At the end of treatment, the improvement in PCS in the intervention group was significant (difference in PCS score at week 4, - 6.718 [95% CI - 11.872 to - 1.564]). We also found significant changes in PCS in the control group (- 6.326 [95% CI, - 11.250 to - 1.401]) at the 16-week follow-up. As for PSEQ, there were no apparent differences between the two groups. There were no adverse events relented to study participation.

CONCLUSIONS

The pilot study is feasible to deliver, and our results indicate that participants in the group of m-health-based CSE combined with SCT may experience faster relief from pain intensity and back disability than those in the group of m-health-based CSE alone.

TRIAL REGISTRATION

ChiCTR2100042810.

The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

BACKGROUND

The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases.

METHODS

This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles.

RESULTS

As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy.

CONCLUSIONS

As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.