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Importance of paravertebral muscle quality in the etiology of degenerative lumbar spinal stenosis

Yıl 2023, Cilt: 9 Sayı: 3, 502 - 510, 04.05.2023

İsmail Kaya

https://doi.org/10.18621/eurj.997335

Öz

Objectives: Degenerative lumbar spinal stenosis (DLSS) is the leading cause of pain, disability, and loss of independence in older adults. In this study, the relationship between DLSS and paravertebral muscle thickness and density was investigated using computed tomography (CT) and magnetic resonance imaging (MRI) methods. Thus, the importance of muscles has been examined to take precautions in the name of preventive medicine.

Methods: This study was planned as a cross-sectional study. The patient group (n = 77) who had surgery for DLSS and the control group (n = 77) were examined. A total of 154 participants (55 females and 22 males in each group) were evaluated retrospectively in terms of cross-sectional area (CSA) and density in the psoas, erector spina and multifidus muscles. In both groups age, gender and body mass index values equalized. Measurements was averaged from the mid-lumbar 3 level from both sides and multi-points.


Results: There was no significant difference between muscle thicknesses (p > 0.05). When evaluated in terms of muscle densities, a significant difference was found between the patient and the control group in terms of psoas muscle (p < 0.05). Likewise, there is the same relationship between erector spinae muscle density and multifidus muscle density (p < 0.05).

Conclusions: Roughly no difference was found between the patient and control groups in terms of CSA of the psoas, erector spinae and multifidus muscles, but it was observed that the muscle density, especially in the multifidus, decreased significantly in the patients. Our results suggest that paravertebral muscle density assessment is an important criterion in disease prediction and can inform preventive treatment.

Anahtar Kelimeler

Paravertebral muscle quality degenerative lumbar spinal stenosis preventive medicine literature review

Teşekkür

I am grateful to Prof. Dr. Ünal ÖZÜM and my apprentice Giray Güneş for their support for the article.

Kaynakça

  • 1. Panjabi M, Abumi K, Duranceau J, Oxland T. Spinal stability and intersegmental muscle forces. A biomechanical model. Spine (Phila Pa 1976) 1989;14:194-200.
  • 2. Bozkurt H, Kaya İ, Oztoprak B. The role of triangular vertebral canal shape in surgical management of patients with lumbar spinal stenosis: a cross-sectional study. Turk Neurosurg 2018;28:792-8.
  • 3. Kirkaldy-Willis WH, McIvor GW. Editorial: Lumbar spinal stenosis. Clin Orthop Relat Res 1976;(115):2-3.
  • 4. Abbas J, Hamoud K, Masharawi YM, May H, Hay O, Medlej B, et al. Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine (Phila Pa 1976) 2010;35:1225-30.
  • 5. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982;(165):110-23.
  • 6. Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 1995;50 Spec No:11-16.
  • 7. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000;9:266-72.
  • 8. Keller A, Gunderson R, Reikerås O, Brox JI. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976) 2003;28):1455-60.
  • 9. Sollmann N, Dieckmeyer M, Schlaeger S, Rohrmeier A, Syvaeri J, Diefenbach MN, et al. Associations between lumbar vertebral bone marrow and paraspinal muscle fat compositions-An investigation by chemical shift encoding-based water-fat MRI. Front Endocrinol (Lausanne) 2018;9:563.
  • 10. Battié MC, Niemelainen R, Gibbons LE, Dhillon S. Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J 2012;12:932-9.
  • 11. Bouche KG, Vanovermeire O, Stevens VK, Coorevits PL, Caemaert JJ, Cambier DC, et al. Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients. BMC Musculoskelet Disord 2011;12:65.
  • 12. Chan ST, Fung PK, Ng NY, Ngan TL, Chong MY, Tang CN, et al. Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. Spine J 2012;12:381-8.
  • 13. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, et al. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2005;60:882-7.
  • 14. 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.
  • 15. Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 2010;19:1136-44.
  • 16. Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology 1984;26:9-13.
  • 17. Paalanne N, Niinimäki 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.
  • 18. Parkkola R, Rytökoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976) 1993;18:830-6.
  • 19. Steurer J, Roner S, Gnannt R, Hodler J; LumbSten Research Collaboration. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 2011;12:175.
  • 20. Abbas J, Slon V, May H, Peled N, Hershkovitz I, Hamoud K. Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis? BMC Musculoskelet Disord 2016;17:422.
  • 21. Han JS, Ahn JY, Goel VK, Takeuchi R, McGowan D. CT-based geometric data of human spine musculature. Part I. Japanese patients with chronic low back pain. J Spinal Disord 1992;5:448-58.
  • 22. Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine (Phila Pa 1976) 2000;25:1509-14.
  • 23. Machado GC, Maher CG, Ferreira PH, Harris IA, Deyo RA, McKay D, et al. Trends, complications, and costs for hospital admission and surgery for lumbar spinal stenosis. Spine (Phila Pa 1976) 2017;42:1737-43.
  • 24. Pope MH, Panjabi M. Biomechanical definitions of spinal instability. Spine (Phila Pa 1976) 1985;10:255-6.
  • 25. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB. Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine (Phila Pa 1976) 2006;31:1888-99.
  • 26. Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine (Phila Pa 1976) 1995;20:192-8.
  • 27. Haig AJ. Paraspinal denervation and the spinal degenerative cascade. Spine J 2002;2:372-80.
  • 28. Leinonen V, Määttä S, Taimela S, Herno A, Kankaanpää M, Partanen J, et al. Paraspinal muscle denervation, paradoxically good lumbar endurance, and an abnormal flexion-extension cycle in lumbar spinal stenosis. Spine (Phila Pa 1976) 2003;28:324-31.
  • 29. Patel CK, Truumees E. Spinal stenosis: pathophysiology, clinical diagnosis, and differential diagnosis. In: Rothman-Simeone the Spine: Expert Consult. Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, eds., vol. 2, 6th ed., Philadelphia: Elsevier Saunders, 2011: pp.1064-77.

Yıl 2023, Cilt: 9 Sayı: 3, 502 - 510, 04.05.2023

İsmail Kaya

https://doi.org/10.18621/eurj.997335

Öz

Kaynakça

  • 1. Panjabi M, Abumi K, Duranceau J, Oxland T. Spinal stability and intersegmental muscle forces. A biomechanical model. Spine (Phila Pa 1976) 1989;14:194-200.
  • 2. Bozkurt H, Kaya İ, Oztoprak B. The role of triangular vertebral canal shape in surgical management of patients with lumbar spinal stenosis: a cross-sectional study. Turk Neurosurg 2018;28:792-8.
  • 3. Kirkaldy-Willis WH, McIvor GW. Editorial: Lumbar spinal stenosis. Clin Orthop Relat Res 1976;(115):2-3.
  • 4. Abbas J, Hamoud K, Masharawi YM, May H, Hay O, Medlej B, et al. Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine (Phila Pa 1976) 2010;35:1225-30.
  • 5. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982;(165):110-23.
  • 6. Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 1995;50 Spec No:11-16.
  • 7. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000;9:266-72.
  • 8. Keller A, Gunderson R, Reikerås O, Brox JI. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976) 2003;28):1455-60.
  • 9. Sollmann N, Dieckmeyer M, Schlaeger S, Rohrmeier A, Syvaeri J, Diefenbach MN, et al. Associations between lumbar vertebral bone marrow and paraspinal muscle fat compositions-An investigation by chemical shift encoding-based water-fat MRI. Front Endocrinol (Lausanne) 2018;9:563.
  • 10. Battié MC, Niemelainen R, Gibbons LE, Dhillon S. Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J 2012;12:932-9.
  • 11. Bouche KG, Vanovermeire O, Stevens VK, Coorevits PL, Caemaert JJ, Cambier DC, et al. Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients. BMC Musculoskelet Disord 2011;12:65.
  • 12. Chan ST, Fung PK, Ng NY, Ngan TL, Chong MY, Tang CN, et al. Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. Spine J 2012;12:381-8.
  • 13. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, et al. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2005;60:882-7.
  • 14. 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.
  • 15. Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 2010;19:1136-44.
  • 16. Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology 1984;26:9-13.
  • 17. Paalanne N, Niinimäki 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.
  • 18. Parkkola R, Rytökoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976) 1993;18:830-6.
  • 19. Steurer J, Roner S, Gnannt R, Hodler J; LumbSten Research Collaboration. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 2011;12:175.
  • 20. Abbas J, Slon V, May H, Peled N, Hershkovitz I, Hamoud K. Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis? BMC Musculoskelet Disord 2016;17:422.
  • 21. Han JS, Ahn JY, Goel VK, Takeuchi R, McGowan D. CT-based geometric data of human spine musculature. Part I. Japanese patients with chronic low back pain. J Spinal Disord 1992;5:448-58.
  • 22. Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine (Phila Pa 1976) 2000;25:1509-14.
  • 23. Machado GC, Maher CG, Ferreira PH, Harris IA, Deyo RA, McKay D, et al. Trends, complications, and costs for hospital admission and surgery for lumbar spinal stenosis. Spine (Phila Pa 1976) 2017;42:1737-43.
  • 24. Pope MH, Panjabi M. Biomechanical definitions of spinal instability. Spine (Phila Pa 1976) 1985;10:255-6.
  • 25. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB. Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine (Phila Pa 1976) 2006;31:1888-99.
  • 26. Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine (Phila Pa 1976) 1995;20:192-8.
  • 27. Haig AJ. Paraspinal denervation and the spinal degenerative cascade. Spine J 2002;2:372-80.
  • 28. Leinonen V, Määttä S, Taimela S, Herno A, Kankaanpää M, Partanen J, et al. Paraspinal muscle denervation, paradoxically good lumbar endurance, and an abnormal flexion-extension cycle in lumbar spinal stenosis. Spine (Phila Pa 1976) 2003;28:324-31.
  • 29. Patel CK, Truumees E. Spinal stenosis: pathophysiology, clinical diagnosis, and differential diagnosis. In: Rothman-Simeone the Spine: Expert Consult. Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, eds., vol. 2, 6th ed., Philadelphia: Elsevier Saunders, 2011: pp.1064-77.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Original Article
Yazarlar

İsmail Kaya 0000-0002-4128-5845

Yayımlanma Tarihi 4 Mayıs 2023
Gönderilme Tarihi 19 Eylül 2021
Kabul Tarihi 6 Ocak 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 9 Sayı: 3

Kaynak Göster

AMA Kaya İ. Importance of paravertebral muscle quality in the etiology of degenerative lumbar spinal stenosis. Eur Res J. Mayıs 2023;9(3):502-510. doi:10.18621/eurj.997335
 Kapak Resmi İndir

e-ISSN: 2149-3189 


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