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MRI features of the psoas major muscle in patients with low back pain



The purpose was to investigate the changes of the psoas major muscles (PM) cross-sectional area (CSA) and fat infiltration in the PM and to investigate the association between the morphology of the PM and expression of the degenerative changes of lumbar spine in patients with low back pain (LBP).


T2-weighted scans for measurements of the CSA and analysis of fat infiltration were performed on 42 patients and 49 controls using a 1.5 Tesla MR system. For a quantitative analysis of fat tissue infiltration a 4-grade visual scale was used.


Patients had bigger CSA of the PM than controls at the levels of L3/L4 and L4/L5 intervertebral disc (P < 0.05). Patients with apparent degenerative changes of the lumbar spine had smaller CSA of the PM compared to the patients without apparent changes at the levels of L3/L4 and L4/L5 (P < 0.05). At the levels of L4/L5 and L5/S1 patients with present Modic changes in the lumbar vertebral bodies showed smaller CSA of the PM compared to the patients without Modic changes (P < 0.05). However, CSA of the PM in the patients with degenerative changes of lumbar spine and Modic changes was still bigger than the one of the controls. At all analyzed levels correlation between CSAs of the PM and fat infiltration of the lumbar paraspinal muscles was negative.


Results suggest increased activity of the PM in LBP patients but PM also remains active regardless of the presence of degenerative and Modic changes of the lumbar spine.

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  1. Urban JP, Roberts S (2003) Degeneration of the intervertebral disc. Arthr Res Ther 5:120–130

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Kader DF, Wardlaw D, Smith FW (2000) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55:145–149

    Article  PubMed  CAS  Google Scholar 

  4. Standring S (2005) Gray’s anatomy, 39th edn. The anatomical basis of clinical practice. Elsevier, Curchill Livingstone, Edinburgh, pp 1444–1446

  5. Penning L (2002) Spine stabilization by psoas muscle during walking and running. Eur Spine J 11:89–90

    Article  PubMed  CAS  Google Scholar 

  6. Penning L (2000) Psoas muscle and lumbar spine stability: a concept uniting existing controversies. Eur Spine J 9:577–585

    Article  PubMed  CAS  Google Scholar 

  7. Bogduk N, Pearcy M, Hadfield G (1992) Anatomy and biomechanics of psoas major. Clin Biomech 7:109–119

    Article  CAS  Google Scholar 

  8. Dangaria TR, Naesh O (1998) Changes in cross-sectional area of psoas major muscle in unilateral sciatica caused by disc herniation. Spine 23:928–931

    Article  PubMed  CAS  Google Scholar 

  9. Barker KL, Shamley DR, Jackson D (2004) Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine 29:E515–E519

    Article  PubMed  Google Scholar 

  10. Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A (2011) Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol 84:709–713

    Article  PubMed  CAS  Google Scholar 

  11. Parkkola R, Rytökoski U, Kormano M (1993) Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 18:830–836

    Article  PubMed  CAS  Google Scholar 

  12. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 9:266–272

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Videman T, Battié MC, Gill K, Manninen H, Gibbons LE, Fisher LD (1995) Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 20:928–935

    Article  PubMed  CAS  Google Scholar 

  16. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB (2006) Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine 31:1888–1899

    Article  PubMed  Google Scholar 

  17. Zhao F, Pollintine P, Hole BD, Dolan P, Adams MA (2005) Discogenic origins of spinal instability. Spine 30:2621–2630

    Article  PubMed  Google Scholar 

  18. Ranson CA, Burnett AF, Kerslake R, Batt ME, O’Sullivan PB (2006) An investigation into the use of MR imaging to determine the functional cross-sectional area of lumbar paraspinal muscles. Eur Spine J 15:764–773

    Article  PubMed  Google Scholar 

  19. Hides J, Gilmore C, Stanton W, Bohlscheid E (2008) Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 13:43–49

    Article  PubMed  Google Scholar 

  20. Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245:43–61

    Article  PubMed  Google Scholar 

  21. Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol 29:838–842

    Article  PubMed  CAS  Google Scholar 

  22. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982

    Article  PubMed  Google Scholar 

  23. Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180

    Article  PubMed  Google Scholar 

  24. Crombez G, Vervaet L, Lysens R, Baeyens F, Eelen P (1998) Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behav Modif 22:62–77

    Article  PubMed  CAS  Google Scholar 

  25. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Juraj Arbanas.

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Arbanas, J., Pavlovic, I., Marijancic, V. et al. MRI features of the psoas major muscle in patients with low back pain. Eur Spine J 22, 1965–1971 (2013).

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  • Psoas major muscle
  • Low back pain
  • MRI
  • Disc degeneration
  • Modic changes