DOI QR코드

DOI QR Code

Factors associated with paravertebral muscle cross-sectional area in patients with chronic low back pain

  • Cankurtaran, Damla (Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital) ;
  • Yigman, Zeynep Aykin (Polatli Duatepe State Hospital, Physical Medicine and Rehabilitation Clinic) ;
  • Umay, Ebru (Polatli Duatepe State Hospital, Physical Medicine and Rehabilitation Clinic)
  • Received : 2021.05.03
  • Accepted : 2021.07.06
  • Published : 2021.10.01

Abstract

Background: This study was performed to reveal the relationships between the cross-sectional areas (CSAs) of the paraspinal muscles and the severity of low back pain (LBP), including the level of disability. Methods: This single-center cross-sectional study was conducted on 164 patients with chronic LBP. The effects of demographic characteristics, posture, level of physical activity, disc herniation type, and sarcopenia risk on the CSAs of paraspinal muscles were evaluated along with the relationship between the CSAs and severity of pain and disability in all patients. The CSAs of paraspinal muscles were evaluated using the software program Image J 1.53. Results: A negative significant correlation was found between age and the paraspinal muscle's CSA (P < 0.05), whereas a positive correlation was present between the level of physical activity and the CSA of the paraspinal muscle at the L2-3 and L3-4 levels. The CSAs of paraspinal muscles in patients with sarcopenia risk was significantly lower than those in patients without sarcopenia risk (P < 0.05). The CSAs of paraspinal muscles at the L2-3 and L3-4 levels in obese patients were significantly higher than those in overweight patients (P = 0.028, P = 0.026, respectively). There was no relationship between the CSAs of paraspinal muscles and pain intensity or disability. Conclusions: Although this study did not find a relationship between paraspinal CSAs and pain or disability, treatment regimens for preventing paraspinal muscles from atrophy may aid pain physicians in relieving pain, restoring function, and preventing recurrence in patients with chronic LBP.

Keywords

Acknowledgement

We are grateful to all our participants.

References

  1. Rezazadeh F, Taheri N, Okhravi SM, Hosseini SM. The relationship between cross-sectional area of multifidus muscle and disability index in patients with chronic non-specific low back pain. Musculoskelet Sci Pract 2019; 42: 1-5. https://doi.org/10.1016/j.msksp.2019.03.005
  2. Schembri E, Massalha V, Spiteri K, Camilleri L, Lungaro-Mifsud S. Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain: is there an association? Korean J Pain 2020; 33: 359-77. https://doi.org/10.3344/kjp.2020.33.4.359
  3. Ranger TA, Cicuttini FM, Jensen TS, Heritier S, Urquhart DM. Paraspinal muscle cross-sectional area predicts low back disability but not pain intensity. Spine J 2019; 19: 862-8. https://doi.org/10.1016/j.spinee.2018.12.004
  4. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389: 736-47. https://doi.org/10.1016/S0140-6736(16)30970-9
  5. Paalanne N, Niinimaki J, Karppinen J, Taimela S, Mutanen P, Takatalo J, et al. Assessment of association between low back pain and paraspinal muscle atrophy using opposed-phase magnetic resonance imaging: a population-based study among young adults. Spine (Phila Pa 1976) 2011; 36: 1961-8. https://doi.org/10.1097/BRS.0b013e3181fef890
  6. Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician 2016; 19: E985-1000.
  7. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 2015; 15: 1593-601. https://doi.org/10.1016/j.spinee.2015.03.039
  8. Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976) 2006; 31: 2926-33. https://doi.org/10.1097/01.brs.0000248453.51165.0b
  9. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine (Phila Pa 1976) 2004; 29: E515-9. https://doi.org/10.1097/01.brs.0000144405.11661.eb
  10. Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H, et al. New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine (Phila Pa 1976) 2016; 41: E84-90. https://doi.org/10.1097/BRS.0000000000001154
  11. Fortin M, Yuan Y, Battie MC. Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther 2013; 93: 1540-50. https://doi.org/10.2522/ptj.20130051
  12. WHO Regional Office for Europe. Body mass index - BMI [Internet]. Copenhagen: WHO Regional Office for Europe; Available at: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/bodymass-index-bmi.
  13. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc 2010; 85: 752-7. https://doi.org/10.4065/mcp.2010.0138
  14. Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9: 671-5. https://doi.org/10.1038/nmeth.2089
  15. Divi SN, Makanji HS, Kepler CK, Anderson DG, Goyal DKC, Warner ED, et al. Does the size or location of lumbar disc herniation predict the need for operative treatment? Global Spine J 2020. doi: 10.1177/2192568220948519.
  16. Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, WoodDauphinee S, Lamping DL, et al. The Quebec Back Pain Disability Scale. Measurement properties. Spine (Phila Pa 1976) 1995; 20: 341-52. https://doi.org/10.1097/00007632-199502000-00016
  17. McRoberts LB, Cloud RM, Black CM. Evaluation of the New York Posture Rating Chart for assessing changes in postural alignment in a garment study. Cloth Text Res J 2013; 31: 81-96. https://doi.org/10.1177/0887302X13480558
  18. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381-95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
  19. Savci S, Ozturk M, Arikan H, Inal Ince D, Tokgozoglu L. [Physical activity levels of university students]. Turk Kardiyol Dern Ars 2006; 34: 166-72. Turkish.
  20. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011; 12: 249-56. https://doi.org/10.1016/j.jamda.2011.01.003
  21. Mannion AF, Kaser L, Weber E, Rhyner A, Dvorak J, Muntener M. Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. Eur Spine J 2000; 9: 273-81. https://doi.org/10.1007/s005860000189
  22. Parkkola R, Kormano M. Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. J Spinal Disord 1992; 5: 86-92. https://doi.org/10.1097/00002517-199203000-00011
  23. Thakar S, Sivaraju L, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases. J Neurosurg Spine 2016; 24: 679-85. https://doi.org/10.3171/2015.9.SPINE15705
  24. Sakai Y, Matsui H, Ito S, Hida T, Ito K, Koshimizu H, et al. Sarcopenia in elderly patients with chronic low back pain. Osteoporos Sarcopenia 2017; 3: 195-200. https://doi.org/10.1016/j.afos.2017.09.001
  25. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology (Bethesda) 2015; 30: 30-9. https://doi.org/10.1152/physiol.00024.2014
  26. Kalichman L, Carmeli E, Been E. The association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int 2017; 2017: 2562957. https://doi.org/10.1155/2017/2562957
  27. Tomlinson DJ, Erskine RM, Morse CI, Winwood K, Onambele-Pearson G. The impact of obesity on skeletal muscle strength and structure through adolescence to old age. Biogerontology 2016; 17: 467-83. https://doi.org/10.1007/s10522-015-9626-4
  28. Su CA, Kusin DJ, Li SQ, Ahn UM, Ahn NU. The association between body mass index and the prevalence, severity, and frequency of low back pain: data from the Osteoarthritis Initiative. Spine (Phila Pa 1976) 2018; 43: 848-52. https://doi.org/10.1097/BRS.0000000000002601
  29. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000; 55: 145-9. https://doi.org/10.1053/crad.1999.0340
  30. Hyun JK, Lee JY, Lee SJ, Jeon JY. Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy. Spine (Phila Pa 1976) 2007; 32: E598-602. https://doi.org/10.1097/BRS.0b013e318155837b
  31. Kim WJ, Kim KJ, Song DG, Lee JS, Park KY, Lee JW, et al. Sarcopenia and back muscle degeneration as risk factors for back pain: a comparative study. Asian Spine J 2020; 14: 364-72. https://doi.org/10.31616/asj.2019.0125
  32. Dzik KP, Skrobot W, Kaczor KB, Flis DJ, Karnia MJ, Libionka W, et al. Vitamin D deficiency is associated with muscle atrophy and reduced mitochondrial function in patients with chronic low back pain. Oxid Med Cell Longev 2019; 2019: 6835341.
  33. van Weering M, Vollenbroek-Hutten MM, Kotte EM, Hermens HJ. Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review. Clin Rehabil 2007; 21: 1007-23. https://doi.org/10.1177/0269215507078331
  34. James G, Klyne DM, Millecamps M, Stone LS, Hodges PW. ISSLS Prize in Basic science 2019: physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration. Eur Spine J 2019; 28: 893-904. https://doi.org/10.1007/s00586-019-05902-9
  35. Cuellar WA, Wilson A, Blizzard CL, Otahal P, Callisaya ML, Jones G, et al. The assessment of abdominal and multifidus muscles and their role in physical function in older adults: a systematic review. Physiotherapy 2017; 103: 21-39. https://doi.org/10.1016/j.physio.2016.06.001
  36. Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, et al. The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 1993; 18: 568-74. https://doi.org/10.1097/00007632-199304000-00008
  37. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 2007; 5: 2. https://doi.org/10.1186/1741-7015-5-2
  38. D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther 2012; 17: 584-8. https://doi.org/10.1016/j.math.2012.06.007