Changes in the paravertebral muscles in patients with degenerative diseases of the lumbar spine
Keywords:degenerative diseases, lumbar spine, paravertebral muscles
Studying of changes in paravertebral muscles is necessary for understanding the prognosis of the course, developing strategies for the prevention and treatment of patients with degenerative diseases of the spine.
Objective: to determine changes in paravertebral muscles in patients with degenerative diseases of the lumbar spine.
Methods: 129 patients who were operated on the reason of instability, intervertebral disc hernias, spondylolisthesis, spinal stenosis, and 11 healthy volunteers were examined on a spiral computer tomograph SOMATOM Emotion. The content of fat, muscle and connective tissues in the paravertebral muscles was determined with the help of an original computer program. A correlation analysis for the assessment was performed.
Results: in patients with intervertebral discs hernias, spondylolisthesis and stenosis of the vertebral canal, the fat content in the paravertebral muscles was higher than in the control group (7.24 ± 1.56) and (16.03 ± 1.62); (18.40 ± 2.17) and (19.70 ± 2.36) % relatively. The differences were more pronounced in m. multifidus and m. erector spinae. A significant decrease in the amount of muscle tissue was observed in patients with s pondylolisthesis (M–W U = 95, Z = –2.51082, p = 0.01) and stenosis (M–W U = 39, p = 0.007). The most pronounced changes, as in the case of fat tissue, were found in m. erector spine and m. multifidus. The content of connective tissue in groups with herniated intervertebral discs, spondylolisthesis and spinal stenosis did not differ from the control parameters, and in patients with instability its quantity was significantly higher.
Conclusions: degenerative changes in the muscles directly correlate with disorders of other structures of the spine and progress depending on the diagnosis in the order: «instability – herniated intervertebral disc – spondylolisthesis – stenosis of the spinal canal».
Bulcke, J. A., Termote, J. L., Palmers, Y., & Crolla, D. (1979). Computed tomography of the human skeletal muscular system. Neuroradiology, 17 (3), 127–136.
Haggmark, T., Jansson, E., & Svane, B. (1978). Cross-sectional area of the thigh muscle in man measured by computed tomography. Scandinavian Journal of Clinical and Laboratory Investigation, 38(4), 355–360. doi:10.3109/00365517809108434
Maughan, R. J., Watson, J. S., & Weir, J. (1984). Muscle strength and cross-sectional area in man: a comparison of strength-trained and untrained subjects. British Journal of Sports Medicine, 18(3), 149–157. doi:10.1136/bjsm.18.3.149
Mayer, T. G., Vanharanta, H., Gatchel, R. J., Mooney, V., Barnes, D., Judge, L., … Terry, A. (1989). Comparison of CT Scan Muscle Measurements and Isokinetic Trunk Strength in Postoperative Patients. Spine, 14(1), 33–36. doi:10.1097/00007632-198901000-00006
Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., De Cuyper, H. J., & Danneels, L. (2000). CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. European Spine Journal, 9(4), 266–272. doi:10.1007/s005860000190
Keller, A., Gunderson, R., Reikerås, O., & Brox, J. I. (2003). Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine, 28(13), 1455–1460. doi:10.1097/01.brs.0000067094.55003.ad
Kalichman, L., Carmeli, E., & Been, E. (2017). The association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. BioMed Research International, 2017, 1–14. doi:10.1155/2017/2562957
Kalichman, L., Hodges, P., Li, L., Guermazi, A., & Hunter, D. J. (2010). Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. European Spine Journal, 19(7), 1136–1144. http://doi.org/10.1007/s00586-009-1257-5
Laasonen, E. M. (1984). Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology, 26(1), 9–13. doi:10.1007/bf00328195
Skidanov, A., Avrunin, A., Tymkovych, M., Zmiyenko, Y., Levitskaya, L., Mischenko, L., & Radchenko, V. (2015). Assessment of paravertebral soft tissues using computed tomography. Orthopaedics, Traumatology and Prosthetics, 3, 61–64. doi:http://dx.doi.org/10.15674/0030-59872015361-64 (in Ukrainian)
Skidanov, A., Avrunin, A., Radchenko, V., Tymkovych, M., & Nessonova M. (2016). Method for determining the structure of paravertebral muscles using computed tomography Patent No. 111269 UA (in Ukrainian)
Kalichman, L. M., Klindukhov, A., & Linov, L. (2016). Indices of paraspinal muscles degeneration: reliability and association with facet joint osteoarthritis: feasibility stu. Clinical Spine Surgery, 29(9), 465–470. doi:10.1097/bsd.0b013e31828be943
Vettor, R., Milan, G., Franzin, C., Sanna, M., De Coppi, P., Rizzuto, R., & Federspil, G. (2009). The origin of intermuscular adipose tissue and its pathophysiological implications. American Journal of Physiology-Endocrinology and Metabolism, 297(5), E987–E998. doi:10.1152/ajpendo.00229.2009
Takayama, K., Kita, T., Nakamura, H., Kanematsu, F., Yasunami, T., Sakanaka, H., & Yamano, Y. (2016). New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine, 41(2), E84–E90. doi:10.1097/brs.0000000000001154
Berry, D. B., Padwal, J., Johnson, S., Parra, C. L., Ward, S. R., & Shahidi, B. (2018). Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine. BMC Musculoskeletal Disorders, 19(1). doi:10.1186/s12891-018-2059-x
Sorensen, S. J., Kjaer, P., Jensen, S. T., & Andersen, P. (2006). Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiologica, 47(9), 947–953. doi:10.1080/02841850600965062
Kjaer, P., Bendix, T., Sorensen, J. S., Korsholm, L., & Leboeuf-Yde, C. (2007). Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Medicine, 5(1). doi:10.1186/1741-7015-5-2
Radchenko, V., Skidanov, A., Morozenko, D., Zmiyenko, Y., Mischenko, L., & Nessonova, M. (2017). Age related content of different tissues in the lumbar spine paravertebral muscles with degenerative diseases. Orthopaedics, Traumatology and Prosthetics, 1, 80–86. doi:http://dx.doi.org/10.15674/0030-59872017180-86 (in Ukrainian)
Shahidi, B., Parra, C. L., Berry, D. B., Hubbard, J. C., Gombatto, S., Zlomislic, V., … Ward, S. R. (2017). Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine, 42(8), 616–623. doi:10.1097/brs.0000000000001848
Goutallier, D., Postel, J., Bernageau, J., Lavau, L., & Voisin, M. (1994). Fatty muscle degeneration in cuff ruptures. Clinical Orthopaedics and Related Research, (304), 78–83. doi:10.1097/00003086-199407000-00014
Klineberg, E., Ching, A., Mundis, G., Burton, D., & Bess, S. (2015). Diagnosis, treatment, and complications of adult lumbar disk herniation: evidence-based data for the healthcare professional. Instructional Course Lectures, 64, 405–416.
Yanik, B., Keyik, B., & Conkbayir, I. (2012). Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging. Skeletal Radiology, 42(6), 771–778. doi:10.1007/s00256-012-1545-8
Kim, W. H., Lee, S.-H., & Lee, D. Y.(2011). Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. Journal of Korean Neurosurgical Society, 50(3), 201–204. doi: 10.3340/jkns.2011.50.3.201
Chan, S., Fung, P., Ng, N., Ngan, T., Chong, M., Tang, C., … Zheng, Y. (2012). Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. The Spine Journal, 12(5), 381–388. doi:10.1016/j.spinee.2011.12.004
Niemelainen, R., Briand, M., & Battie, M. C. (2011). Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine, 36(25), 2152–2157. doi:10.1097/brs.0b013e318204b05a
Wang, G., Karki, S. B., Xu, S., Hu, Z., Chen, J., Zhou, Z., & Fan, S. (2015). Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis. Journal of Back and Musculoskeletal Rehabilitation, 28(2), 277–285. doi:10.3233/bmr-140515
Korzh, N. A., Prodan, A. I., & Barysh, A. E. (2004). Pathogenic classification of spine degenerative diseases Orthopaedics, Traumatology and Prosthetics,3, 5–13. (in Russian)
Crawford, R. J., Cornwall, J., Abbott, R., & Elliott, J. M. (2017). Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskeletal Disorders, 18(1). doi:10.1186/s12891-016-1378-z
Wagner, S. C., Sebastian, A. S., McKenzie, J. C., Butler, J. S., Kaye, I. D., Morrissey, P. B., … Kepler, C. K. (2018). Severe lumbar disability is associated with decreased psoas cross-sectional area in degenerative spondylolisthesis. Global Spine Journal, 219256821876539. doi:10.1177/2192568218765399
Copyright (c) 2018 Volodymyr Radchenko, Artem Skidanov
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available after 6 months from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).