Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

Abstract Background Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology. Methods In 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation. Results No significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region. Conclusions The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.

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Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

10.21203/rs.3.rs-46136/v2 ◽

2020 ◽

Author(s):

Jennifer Padwal ◽

David B Berry ◽

James C. Hubbard ◽

Vinko Zlomislic ◽

R. Todd Allen ◽

...

Keyword(s):

Lumbar Spine ◽

Muscle Activation ◽

Spinous Process ◽

Cross Sectional Area ◽

Degenerative Changes ◽

Sectional Area ◽

Cross Sectional ◽

Spine Stabilization ◽

Spine Pathology ◽

Deep Region

Abstract Background: Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology.Methods: In 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation. Results: No significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region. Conclusions: The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.

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Is a single-level measurement of paraspinal muscle fat infiltration and cross-sectional area representative of the entire lumbar spine?

Skeletal Radiology ◽

10.1007/s00256-018-2902-z ◽

2018 ◽

Vol 47 (7) ◽

pp. 939-945 ◽

Cited By ~ 10

Author(s):

Julio Urrutia ◽

Pablo Besa ◽

Daniel Lobos ◽

Marcelo Andia ◽

Cristobal Arrieta ◽

...

Keyword(s):

Lumbar Spine ◽

Cross Sectional Area ◽

Paraspinal Muscle ◽

Sectional Area ◽

Cross Sectional ◽

Fat Infiltration ◽

Single Level ◽

Level Measurement ◽

Muscle Fat Infiltration

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Cross-Sectional Area of the Lumbar Spine Trunk Muscle and Posterior Lumbar Interbody Fusion Rate

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000424 ◽

2017 ◽

Vol 30 (6) ◽

pp. E798-E803 ◽

Cited By ~ 4

Author(s):

Man Kyu Choi ◽

Sung Bum Kim ◽

Chang Kyu Park ◽

Hridayesh P. Malla ◽

Sung Min Kim

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Trunk Muscle ◽

Cross Sectional Area ◽

Lumbar Interbody Fusion ◽

Sectional Area ◽

Cross Sectional

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High Rates of Overuse-Related Structural Abnormalities in the Lumbar Spine of Youth Competitive Alpine Skiers: A Cross-sectional MRI Study in 108 Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120922554 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712092255 ◽

Cited By ~ 1

Author(s):

Loris Peterhans ◽

Stefan Fröhlich ◽

Christoph Stern ◽

Walter O. Frey ◽

Mazda Farshad ◽

...

Keyword(s):

Lumbar Spine ◽

Disc Degeneration ◽

Height Growth ◽

Cross Sectional Area ◽

Sectional Area ◽

Mri Findings ◽

Cross Sectional ◽

Pars Interarticularis ◽

Structural Abnormalities ◽

Alpine Skiers

Background: Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes. Purpose: To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination. Results: Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions ( P = .018; R2 = 0.116) and end plate changes ( P = .024; R2 = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age ( P = .034; R2 = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes ( P < .05 for all). Conclusion: As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.

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Multiplying linear dimension techniques may predict the cross-sectional area of multifidus muscle at all levels of lumbar spine

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-2012-0324 ◽

2012 ◽

Vol 25 (3) ◽

pp. 171-176 ◽

Cited By ~ 2

Author(s):

Maryamsadat Larrie-Baghal ◽

Amir H. Bakhtiary ◽

Asghar Rezasoltani ◽

Rozita Hedayati ◽

Raheb Ghorbani

Keyword(s):

Lumbar Spine ◽

Linear Dimension ◽

Cross Sectional Area ◽

Sectional Area ◽

Multifidus Muscle ◽

Cross Sectional ◽

The Cross

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Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2960-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Gyeong-tae Gwak ◽

Ui-jae Hwang ◽

Sung-hoon Jung ◽

Hyun-a Kim ◽

Jun-hee Kim ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disc ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Cross Sectional Area ◽

Sectional Area ◽

Endurance Test ◽

Cross Sectional ◽

Significant Difference ◽

Asymptomatic Individuals

Abstract Background Previous studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI). Methods Twenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4–5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups. Results There were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05). Conclusions There was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine. Trial registration number Clinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.

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