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        Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study

        Ogon Izaya,Hiroyuki Takashima,Tomonori Morita,Tsutomu Oshigiri,Yoshinori Terashima,Mitsunori Yoshimoto,Makoto Emori,Atsushi Teramoto,Tsuneo Takebayashi,Toshihiko Yamashita 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

        Study Design: Cross-sectional observational study.Purpose: This study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters.Overview of Literature: The psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents.Methods: The study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed.Results: No association was identified between the EMCL and IMCL contents and LBP VAS scores (<i>r</i>=0.05, <i>p</i>=0.79 and <i>r</i>=0.06, <i>p</i>=0.75, respectively). The EMCL content correlated with age (<i>r</i>=0.47, <i>p</i><0.01), body mass index (BMI) (<i>r</i>=0.44, <i>p</i><0.01), CSA (<i>r</i>=−0.59, <i>p</i>< 0.01), and FI (<i>r</i>=0.49, <i>p</i><0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (<i>r</i>=−0.43, <i>p</i><0.05) and positive correlation with pelvic tilt (PT) (<i>r</i>=0.56, <i>p</i><0.01).Conclusions: EMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major.

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        Relevance between Schmorl’s Node and Lumbar Intervertebral Disc Degeneration Quantified with Magnetic Resonance Imaging T2 Mapping in Chronic Low Back Pain

        Ogon Izaya,Takashima Hiroyuki,Morita Tomonori,Oshigiri Tsutomu,Terashima Yoshinori,Yoshimoto Mitsunori,Fukushi Ryunosuke,Fujimoto Shutaro,Emori Makoto,Teramoto Atsushi,Takebayashi Tsuneo,Yamashita Tos 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

        Study Design: Cross-sectional study.Purpose: The purpose of this study was to elucidate the relevance among Schmorl’s node (SN), chronic low back pain (CLBP), and intervertebral disc degeneration (IVDD) with the use of magnetic resonance imaging T2 mapping.Overview of Literature: SN may be combined with CLBP and/or IVDD; however, their relationship has not been determined to date.Methods: A total of 105 subjects were included (48 men and 57 women; mean age, 63.2±2.7 years; range, 22–84 years). We analyzed five functional spinal unit levels (L1–S1) and evaluated the T2 values of the anterior annulus fibrosus (AF), nucleus pulposus, and posterior AF. We compared the low back pain (LBP) Visual Analog Scale (VAS) scores and the T2 values in each decade with or without SN.Results: There were no remarkable differences in SN prevalence rate regarding age decade or gender. SNs were more prevalent in the upper 2 levels (70.3%). LBP VAS scores with and without SN were 64.7±4.3 mm and 61.9±2.8 mm, respectively, with no significant differences between the groups (p =0.62). The T2 values of anterior AF with SN were significantly lower than those without SN in patients in their 50s, 60s, 70s, and 80s (p <0.01).Conclusions: SN presence is not itself a risk factor for CLBP; however, it indicates IVDD of the anterior AF in subjects with SN who are ≥50 years old.

      • Magnetic Resonance Spectroscopic Analysis of Multifidus Muscle Lipid Contents and Association with Nociceptive Pain in Chronic Low Back Pain

        Ogon Izaya,Iba Kouske,Takashima Hiroyuki,Yoshimoto Mitsunori,Morita Tomonori,Oshigiri Tsutomu,Terashima Yoshinori,Emori Makoto,Teramoto Atsushi,Takebayashi Tsuneo,Yamashita Toshihiko 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

        Study Design: Cross-sectional study.Purpose: This study aimed to analyze the differences in the lipid contents in chronic low back pain (CLBP) patients with nociceptive pain (NocP) and neuropathic pain (NeP) using magnetic resonance spectroscopy (MRS) of the multifidus muscle (Mm).Overview of Literature: Early identification of the pain characteristics with CLBP is important because specific treatment approaches are required, depending on NocP and NeP.Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41–79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire.Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4–833.1) and 484.8 mmol/L (95% CI, 381.1–588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6–7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3–6,817.9), respectively; however, the difference was not significant (p=0.72).Conclusions: The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

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