multifidus muscle
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Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Raheem Sarafadeen ◽  
Sokunbi O. Ganiyu ◽  
Aminu A. Ibrahim ◽  
Anas Ismail ◽  
Mukadas O. Akindele ◽  
...  

Abstract Background Structural impairment of the lumbar multifidus muscle, such as reduced cross-sectional area, is evident among individuals with chronic low back pain. Real-time ultrasound imaging (RUSI) biofeedback has been reported to improve preferential activation of as well as retention in the ability to activate the lumbar multifidus muscle during lumbar stabilization exercises (LSE). However, evidence of the effectiveness of this treatment approach in individuals with non-specific chronic low back pain (NCLBP) is still limited. The purpose of this study is, therefore, to determine the effectiveness of LSE with RUSI biofeedback on lumbar multifidus muscle cross-sectional area in individuals with NCLBP. Methods/Design This study is a prospective, single-center, assessor-blind, three-arm, parallel randomized controlled trial to be conducted at National Orthopedic Hospital, Kano State, Nigeria. Ninety individuals with NCLBP will be randomized in a 1:1:1: ratio to receive LSE, LSE with RUSI biofeedback, or minimal intervention. All participants will receive treatment twice weekly for 8 weeks. The primary outcome will be the lumbar multifidus muscle cross-sectional area. The secondary outcomes will include pain (Numerical Pain Rating Scale), functional disability (Roland–Morris Disability Questionnaire), and quality of life (12-Item Short-Form Health Survey). All outcomes will be assessed at baseline, 8 weeks post-intervention,  and 3 months follow-up. Discussion To our knowledge, this study will be the first powered randomized controlled trial to compare the effectiveness of LSE training with and without RUSI biofeedback in individuals with NCLBP. The outcome of the study may provide evidence for the effectiveness of LSE with RUSI biofeedback on enhancing the recovery of the lumbar multifidus muscle in individuals with NCLBP. Trial registration Pan African Clinical Trials Registry (PACTR201801002980602). Registered on January 16, 2018.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Peng Yin ◽  
Haifeng Gao ◽  
Lijin Zhou ◽  
Daming Pang ◽  
Yong Hai ◽  
...  

Background. The objective of this study was to investigate the enhanced recovery clinical effects of an innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of patients with LSS and degenerative instability. Methods. From January 2019 to March 2020, 51 patients with single-segment LSS and degenerative instability were prospectively included in our study (ChiCTR1900020679). The Oswestry Disability Index (ODI), the visual analogue scale (VAS) on lumbar and leg pain (VAS-LBP and VAS-LP), serum creatine kinase (CK), the peak intensity of sulphur hexafluoride microbubble contrast agent (PI), and the maximal cross-sectional area of multifidus muscle (Max-CSA) around the surgical incision were assessed preoperatively, postoperatively, and at regular follow-up. Results. All patients were followed up. The mean postoperative bedridden time was 20.45 ± 2.66 hours. The ODI, VAS-LBP, and VAS-LP were improved significantly after operation compared to these data before operation in all the patients ( P < 0.05 ). The CK at 1 day after operation was higher compared to the data before the operation ( P < 0.05 ), and there was no significant difference on CK at 1 week after operation ( P > 0.05 ). The PI at 1 week after operation was higher compared to this item before operation ( P < 0.05 ), and there was no significant difference on PI at 1 month or 3 months after operation ( P > 0.05 ). The Max-CSA at 1 week after operation was higher compared to this item before the operation ( P < 0.05 ), and there was no significant difference in Max-CSA at 1 month or 3 months after operation compared with before the operation ( P > 0.05 ). Conclusions. Our results and systematic review presented the innovative PE-TLIF technique could obtain satisfactory and effective outcomes for the treatment of patients with LSS and degenerative instability. Our PE-TLIF technique also had the ability to decrease the MF injury and obtain an enhanced recovery.


2021 ◽  
pp. 219256822110672
Author(s):  
Vit Kotheeranurak ◽  
Khanathip Jitpakdee ◽  
Guang-Xun Lin ◽  
Akaworn Mahatthanatrakul ◽  
Weerasak Singhatanadgige ◽  
...  

Study Design Retrospective cohort study Objectives This study aimed to report the incidence and potential risk factors of polyetheretherketone (PEEK) cage subsidence following oblique lateral interbody fusion (OLIF) for lumbar degenerative diseases. We proposed also an algorithm to minimize subsidence following OLIF surgery. Methods The study included a retrospective cohort of 107 consecutive patients (48 men and 59 women; mean age, 67.4 years) who had received either single- or multi-level OLIF between 2012 and 2019. Patients were classified into subsidence and non-subsidence groups. PEEK cage subsidence was defined as any violation of either endplate from the computed tomography scan in both sagittal and coronal views. Preoperative variables such as age, sex, body mass index, bone mineral density (BMD) measured by preoperative dual-energy X-ray absorptiometry, smoking status, corticosteroid use, diagnosis, operative level, multifidus muscle cross-sectional area, and multifidus muscle fatty degeneration were collected. Age-related variables (height and length) were also documented. Univariate and multivariate logistic regression analyses were used to analyze the risk factors of subsidence. Results Of the 107 patients (137 levels), 50 (46.7%) met the subsidence criteria. Higher PEEK cage height had the strongest association with subsidence (OR = 9.59, P < .001). Other factors significantly associated with cage subsistence included age >60 years (OR = 3.15, P = .018), BMD <−2.5 (OR = 2.78, P = .006), and severe multifidus muscle fatty degeneration (OR = 1.97, P = .023). Conclusions Risk factors for subsidence in OLIF were age >60 years, BMD < −2.5, higher cage height, and severe multifidus muscle fatty degeneration. Patients who had subsidence had worse early (3 months) postoperative back and leg pain.


2021 ◽  
Vol 13 (2) ◽  
pp. 13-21
Author(s):  
M.Y. Dambele, ◽  
N.A. Yamsat ◽  
S. Raheem ◽  
M.O. Akindele

The stability of the spinal column is largely dependent on the integrity of the spinal muscles, especially the multifidus muscle. However, this important role of the multifidus muscle might be compromised due to both mechanical and non-mechanical causes leading to change in its contents, fat deposition and reduction in the cross-sectional area. This study was carried out to determine the influence of physical activity level and body adiposity indices on lumbar multifidus muscle (LMM) fatty infiltration among individuals with low back pain (LBP). This was a cross-sectional study in which 94 participants, male and female samples with non-specific LBP were recruited conveniently and assessed for LMM fat infiltration, pain intensity, functional disability, physical activity and socio-demographic variables. There were positive and moderate correlations between LMM fatty infiltration body mass index (BMI) (r=0.575, p=0.001), waist circumference (WC) (r=0.514, p=0.001) and gender (r=0.409, p=0.001) for normally distributed data using Pearson moment correlation coefficient. For not normally distributed variables, LMM fatty infiltration was moderately and positively correlated with gender (r=0.422, p=0.001), %body fat (r=0.621, p=0.001), visceral fat (r=0.470, p=0.0001), Oswestry Disability Index (ODI) (r=0.238, p=0.021) and visual analogue scale (VAS) (r=0.232, p=0.024) respectively. However, there was a weak negative correlation between LMM fatty infiltration and occupation (r=p=0.046). There were significant differences between male and female multifidus fat infiltration and body adiposity indices. There was a positive relationship between multifidus fatty infiltration and BMI, gender, %body fat, visceral mass, ODI and VAS, while we observed a negative relationship between lumbar multifidus fatty infiltration and occupation. Furthermore, the best correlate of lumbar multifidus % body fat.  


2021 ◽  
Vol 20 (4) ◽  
pp. 260-263
Author(s):  
Ramon Oliveira Soares ◽  
Nelson Astur ◽  
Fabio Chaud de Paula ◽  
Paulo Simões Forte ◽  
Guilherme Alves de Melo ◽  
...  

ABSTRACT Introduction: The paravertebral musculature is essential for the biomechanics and stability of the spine, and its involvement in the pathophysiology of spinal diseases has been demonstrated. Qualitative evaluation of muscle degeneration is usually performed by analyzing the fat infiltration rate proposed by the Goutallier classification system. Objective: The objective of this study is to analyze the intra- and interobserver agreement of the Goutallier Classification for the evaluation of fatty degeneration of the multifidus muscle, using magnetic resonance imaging exams. Methods: The study included 68 patients, all diagnosed with symptomatic disc hernia and indicated for surgery. Preoperative magnetic resonance images were used for the analyses. The images were initially evaluated by two orthopedists and two medical students, and then re-evaluated after two weeks. Intra- and inter-observer reliability analysis was performed using the Fleiss Kappa test and the Landis and Koch criteria. All the analyses were performed using the R statistical environment (R Development Core Team, version 3.3.1, 2016) and the significance level was set at 5%. Results: The percentages of intra- and inter-observer agreement were 86.76% and 61.03%, respectively. The intraobserver agreement was near perfect and the interobserver agreement was moderate. Conclusion: The Goutallier Classification System showed moderate interobserver and intraobserver agreement, being a relevant tool for the evaluation of paravertebral musculature fat replacement. Level of evidence II; Prospective study for diagnostic purposes.


2021 ◽  
Author(s):  
Maryse Fortin ◽  
Daniel Wolfe ◽  
Geoffrey Dover ◽  
Mathieu Boily

Abstract BackgroundNeuromuscular electrical stimulation (NMES) is used to improve muscle strength clinically when rehabilitating various musculoskeletal disorders. However, the effects of NMES on muscle morphology and function in individuals with non-specific chronic low back pain (CLBP) have scarcely been investigated. Although research links deficits in the paraspinal musculature with subjective reports of pain and disability, it is unknown if treatment with NMES can help reverse these deficits. Therefore, the primary aim of this study is to compare the effects of two muscle therapy protocols with a medium-frequency electrotherapy device (the StimaWELL 120MTRS system) on multifidus muscle morphology in CLBP patients. The secondary aims are to determine the effects of these protocols on multifidus muscle function, as well as subjective reports of pain intensity, pain interference, disability, and catastrophizing. MethodsA total of 30 participants with non-specific CLBP, aged 18-60, will be recruited from local orthopedic clinics and databases. Participants will be randomized (1:1) to either the phasic or combined (phasic + tonic) muscle therapy protocols on the StimaWELL 120MTRS system. Participants will undergo 20 supervised electrotherapy treatments over a 10-week period. The primary outcomes will be multifidus cross-sectional area (CSA) and fat infiltration. Secondary outcomes will include multifidus contraction (measured via %thickness change from a rested to contracted state), multifidus stiffness (at rest, and during contraction), as well as pain intensity, interference, disability, and catastrophizing. Both primary and secondary outcomes will be obtained at baseline and at 11-weeks; secondary outcomes measured via questionnaires will also be obtained at 6-weeks, while low back pain intensity will be measured before and after each treatment. Paired t-tests will be used to assess within-group changes for all primary outcome measures. A two-way repeated-measures analysis of variance will be use to assess changes in secondary outcomes over time. DiscussionThe results of this trial will help clarify the role of medium-frequency NMES on lumbar multifidus morphology and function. Trial RegistrationNCT04891692 Trial SponsorConcordia University, Montreal, Quebec, Canada


Author(s):  
Jørn Aaen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  

Abstract Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.


Author(s):  
Georg Osterhoff ◽  
Garnik Asatryan ◽  
Ulrich J. A. Spiegl ◽  
Christian Pfeifle ◽  
Jan-Sven Jarvers ◽  
...  

AbstractTo assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the index fracture. In a retrospective cohort study, patients who underwent surgery for an OVCF were identified and baseline characteristics, fracture patterns and the occurrence of secondary adjacent fractures within one year were obtained by chart review. Multifidus muscle atrophy and fatty degeneration were determined on preoperative MRI or CT scans. In this analysis of 191 patients (mean age 77 years, SD 8, 116 female), OF type 3 was the most common type of OVCF (49.2%). Symptomatic adjacent OVCFs within one year after index fracture were observed in 23/191 patients (12%) at mean 12, SD 12 weeks (range 1–42 weeks) postoperatively. The mean multifidus muscle area was 264, SD 53 mm2 in patients with an adjacent vertebral fracture and 271, SD 92 mm2 in patients without a secondary fracture (p = 0.755). Mean multifidus fatty infiltration was graded Goutallier 2.2, SD 0.6 in patients with an adjacent fracture and Goutallier 2.2, SD 0.7 in patients without an adjacent fracture (p = 0.694). Pre-existing medication with corticosteroids was associated with the occurrence of an adjacent fracture (p = 0.006). Multifidus area and multifidus fatty infiltration had no significant effect on the occurrence of adjacent vertebral fractures within one year after the index fracture. Patients with a pre-existing medication with corticosteroids were more likely to sustain an adjacent fracture.


Neurospine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 608-617
Author(s):  
Jun Jae Shin ◽  
Byeongwoo Kim ◽  
Juwon Kang ◽  
Junjeong Choi ◽  
Bong Ju Moon ◽  
...  

Objective: This study aimed to identify the sagittal parameters associated with health-related quality of life and genetic variations that increase the risk of adult spinal deformity (ASD) onset in the older population.Methods: We recruited 120 participants who had a sagittal vertical axis > 50 mm in a sagittal imbalance study. Sagittal radiographic parameters, cross-sectional area, and intramuscular fatty infiltration using the Goutallier classification in the paraspinal lumbar muscles were evaluated. Functional scales included the self-reported Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analogue scales (VAS) for back and leg pain. We performed whole-exome sequencing and an exome-wide association study using the 100 control subjects and 63 individuals with severe phenotypes of sagittal imbalance.Results: Pelvic incidence minus lumbar lordosis (PI–LL) mismatch was negatively associated with the SF-36 and positively correlated with ODI and VAS for back and leg pain. PI–LL was related to the quality and size of the paraspinal muscles, especially the multifidus muscle. We identified common individual variants that reached exome-wide significance using single-variant analysis. The most significant single-nucleotide polymorphism was rs78773460, situated in an exon of the SVIL gene (odds ratio, 9.61; p = 1.15 × 10-9).Conclusion: Older age, higher body mass index, and a more significant PI–LL mismatch were associated with unfavorable results on functional scales. We found a genetic variation in the SVIL gene, which has been associated with the integrity of the cytoskeleton and the development of skeletal muscles, in severe ASD phenotypes. Our results help to elucidate the pathogenesis of ASD.


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