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Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation

European Spine Journal volume 25, pages 1452–1459 (2016)Cite this article

Abstract

Purpose

To investigate asymmetry in size and composition of the multifidus and erector spinae in patients with posterolateral disc herniation and concordant radicular symptoms, and determine whether symptom duration is associated with degree of asymmetry.

Methods

Thirty-three patients diagnosed with posterolateral disc herniation at L4–L5 verified on imaging and concordant leg pain were included. Multifidus and erector spinae cross-sectional area (CSA), functional cross-sectional area (FCSA, fat-free area), signal intensity and ratio of FCSA to total CSA were measured bilaterally from T 2-weighted axial magnetic resonance imaging (MRI) at L3–L4, L4–L5, L5–S1 and S1 levels.

Results

No side-to-side differences in multifidus CSA, FCSA, and ratio of FCSA/CSA reached statistical significance at any spinal level. The multifidus signal intensity at L5–S1 was significantly greater (more fatty infiltration) on the side of the disc herniation. The erector spinae FCSA (lean muscle mass) at L5–S1 was found to be significantly smaller on the side of the herniation and the ratio of FCSA/CSA was smaller (more fatty infiltration) on the side of the herniation at L4–L5 and L5–S1. The degree of muscle asymmetry was not associated with symptoms duration.

Conclusions

There was no significant asymmetry of the multifidus at spinal level above, same or level below the disc herniation. Instead, variations in muscle composition were observed, with greater fat infiltration on the side and at spinal levels adjacent to the disc herniation. Muscle asymmetry was not correlated with symptom duration.

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Fig. 1

References

  1. 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(22):E515–E519

    Article  PubMed  Google Scholar 

  2. 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(4):266–272

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Hides J, Gilmore C, Stanton W, Bohlscheid E (2008) Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 13(1):43–49

    Article  PubMed  Google Scholar 

  4. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19(2):165–172

    CAS  Article  PubMed  Google Scholar 

  5. Hyun JK, Lee JY, Lee SJ, Jeon JY (2007) Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy. Spine 32(21):E598–E602

    Article  PubMed  Google Scholar 

  6. Kader DF, Wardlaw D, Smith FW (2000) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55(2):145–149

    CAS  Article  PubMed  Google Scholar 

  7. Mengiardi B, Schmid MR, Boos N, Pfirrmann CWA, Brunner F, Elfering A, Holder J (2006) Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 240(3):786–792

    Article  PubMed  Google Scholar 

  8. Parkkola R, Rytokoski 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(7):830–836

    CAS  Article  PubMed  Google Scholar 

  9. 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(1004):709–713

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Campbell WW, Vasconcelos O, Laine FJ (1998) Focal atrophy of the multifidus muscle in lumbosacral radiculopathy. Muscle Nerve 21(10):1350–1353

    CAS  Article  PubMed  Google Scholar 

  11. Kulig K, Scheid AR, Beauregard R, Popovich JM Jr, Beneck GJ, Colletti PM (2009) Multifidus morphology in persons scheduled for single-level lumbar microdiscectomy: qualitative and quantitative assessment with anatomical correlates. Am J Phys Med Rehabil 88(5):355–361

    Article  PubMed  Google Scholar 

  12. Macintosh JE, Valencia F, Bogduk N, Munro RR (1986) The morphology of the human lumbar multifidus. Clin Biomech 1(4):196–204

    CAS  Article  Google Scholar 

  13. Hodges P, Holm AK, Hansson T, Holm S (2006) Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine 31(25):2926–2933

    Article  PubMed  Google Scholar 

  14. Kim WH, Lee S-, Lee DY (2011) Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc 50(3):201–204

    Article  PubMed  PubMed Central  Google Scholar 

  15. Battié MC, Niemelainen R, Gibbons LE, Dhillon S (2012) Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J 12(10):932–939

    Article  PubMed  Google Scholar 

  16. Stokes MJ, Cooper RG, Morris G, Jayson MIV (1992) Selective changes in multifidus dimensions in patients with chronic low back pain. Eur Spine J 1(1):38–42

    CAS  Article  PubMed  Google Scholar 

  17. Kamath S, Venkatanarasimha N, Walsh MA, Hughes PM (2008) MRI appearance of muscle denervation. Skelet Radiol 37(5):397–404

    CAS  Article  Google Scholar 

  18. Battié MC, Lazáry A, Fairbank J, Eisenstein S, Heywood C, Brayda-Bruno M, Varga PP, McCall I (2013) Disc degeneration-related clinical phenotypes. Eur Spine J 23(Suppl 3):S305–S314

    PubMed  Google Scholar 

  19. Pincus T, Santos R, Breen A, Burton AK, Underwood M (2008) A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Arthritis Rheum 59(1):14–24

    Article  PubMed  Google Scholar 

  20. Fortin M, Battié MC (2012) Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther 92(6):853–864

    Article  PubMed  Google Scholar 

  21. Kang JI, Kim SY, Kim JH, Bang H, Lee IS (2013) The location of multifidus atrophy in patients with a single level, unilateral lumbar radiculopathy. Ann Rehabil Med 37(4):498–504

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lalive PH, Truffert A, Magistris MR (2004) Lombosacral radiculopathy (L3–S1) and specificity of multifidus EMG. Neurophysiol Clin 34(1):41–47

    CAS  Article  PubMed  Google Scholar 

  23. Kottlors M, Glocker FX (2008) Polysegmental innervation of the medial paraspinal lumbar muscles. Eur Spine J 17(2):300–306

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chen YY, Pao JL, Liaw CK, Hsu WI, Yang RS (2014) Image changes of paraspinal muscles and clinical correlations in patients with unilateral lumbar spinal stenosis. Eur Spine J 23(5):999–1006

    Article  PubMed  Google Scholar 

  25. Wan Q, Lin C, Li X, ZengW Ma C (2015) MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol 88(1053):20140546

    CAS  Article  PubMed  Google Scholar 

  26. Fortin M, Yuan Y, Battié MC (2013) Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther 93(11):1540–1550

    Article  PubMed  PubMed Central  Google Scholar 

  27. D’hooge R, Cagnie B, Crombez G, Vandersranten G, Dolphens M, Danneels L (2012) Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther 17(6):584–588

  28. Fortin M, Gibbons LE, Videman T, Battié MC (2015) Do variations in paraspinal muscle morphology and composition predict low back pain in men? Scand J Med Sports 25(6):880–887

    CAS  Article  Google Scholar 

  29. Le Cara EC, Marcus RL, Dempsey AR, Hoffman MD, Hebert JJ (2014) Morphology versus function: the relationship between lumbar multifidus intramuscular adipose tissue and muscle function among patients with low back pain. Arch Phys Med Rehab 95:1846–1852

    Article  Google Scholar 

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Acknowledgments

We thank Laura Gibbons for her help with data requests and statistical consultation. Support was received from the Seventh Framework Programme (Health-2007–2013, Grant agreement no: 201626; GENODISC) and the Canada Research Chairs Program.

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Authors and Affiliations

  1. Common Spinal Disorders Research Group, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, 8205, 114 Street, Edmonton, AB, T6G 2G4, Canada

    Maryse Fortin & Michele C. Battié

  2. National Centre for Spinal Disorders, Budapest, Hungary

    Àron Lazáry & Peter Paul Varga

  3. Robert Jones and Agnes Hunt Orthopaedic Hospital, Keele University, Oswestry, Shropshire, UK

    Iain McCall

Authors
  1. Maryse Fortin
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  2. Àron Lazáry
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  3. Peter Paul Varga
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  4. Iain McCall
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  5. Michele C. Battié
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Correspondence to Michele C. Battié.

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Fortin, M., Lazáry, À., Varga, P.P. et al. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J 25, 1452–1459 (2016). https://doi.org/10.1007/s00586-016-4503-7

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  • DOI: https://doi.org/10.1007/s00586-016-4503-7

Keywords

  • Multifidus
  • Atrophy
  • Fatty infiltration
  • Disc herniation
  • Erector spinae