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

( Damla Cankurtaran ),( Zeynep Aykin Yigman ),( Ebru Umay ) 대한통증학회 2021 The Korean Journal of Pain Vol.34 No.4

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.

Chronic Paraspinal Muscle Injury Model in Rat

Cho, Tack Geun,Park, Seung Won,Kim, Young Baeg The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.5

Objective : The objective of this study is to establish an animal model of chronic paraspinal muscle injury in rat. Methods : Fifty four Sprague-Dawley male rats were divided into experimental group (n=30), sham (n=15), and normal group (n=9). Incision was done from T7 to L2 and paraspinal muscles were detached from spine and tied at each level. The paraspinal muscles were exposed and untied at 2 weeks after surgery. Sham operation was done by paraspinal muscles dissection at the same levels and wound closure was done without tying. Kyphotic index and thoracolumbar Cobb's angle were measured at preoperative, 2, 4, 8, and 12 weeks after the first surgery for all groups. The rats were sacrificed at 4, 8, and 12 weeks after the first surgery, and performed histological examinations. Results : At 4 weeks after surgery, the kyphotic index decreased, but, Cobb's angle increased significantly in the experimental group (p<0.05), and then that were maintained until the end of the experiment. However, there were no significant differences of the kyphotic index and Cobb's angle between sham and normal groups. In histological examinations, necrosis and fibrosis were observed definitely and persisted until 12 weeks after surgery. There were also presences of regenerated muscle cells which nucleus is at the center of cytoplasm, centronucleated myofibers. Conclusion : Our chronic injury model of paraspinal muscles in rats shows necrosis and fibrosis in the muscles for 12 weeks after surgery, which might be useful to study the pathophysiology of the degenerative thoracolumbar kyphosis or degeneration of paraspinal muscles.

근력 운동 후 발생한 급성 요추부 척추 주위 근육의 구획 증후군 - 증례 보고 -

김기원,하지윤,이준석,조용수 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.3

Study Design: Case report. Objectives: To report 2 cases of acute lumbar paraspinal compartment syndrome due to weightlifting. Summary of Literature Review: Acute lumbar paraspinal compartment syndrome is very rare, but it causes muscle necrosis and acute renal failure. Therefore, it should be treated immediately. Materials and Methods: A 31-year-old male patient and a 30-year-old male patient visited the emergency room due to severe back pain. The left paraspinal compartment pressure of the 31-year-old patient was measured as 35 mm Hg using the Whitesides technique. The paraspinal compartment pressure of the 30-year-old patient was measured as 22 mm Hg on the left side and 30 mm Hg on the right side. We diagnosed acute lumbar paraspinal compartment syndrome and performed a fasciotomy. This study received Institutional Review Board approval (ID: SC18ZESE0032). Results: Lab findings improved after fasciotomy. The operative wounds healed after fasciocutaneous flap placement. Conclusions: Acute lumbar paraspinal compartment syndrome is very rare, but should be considered in patients with severe back pain. 연구 계획: 증례 보고목적: 근력 운동 후 발생한 급성 요추부 척추 주위 근육의 구획 증후군 증례 2예를 보고하고자 한다. 선행 연구문헌의 요약: 급성 요추부 척추 주위 근육의 구획 증후군은 매우 드물게 발생하지만 근육 조직의 괴사와 급성 신부전을 일으킬 수 있다. 따라서즉각적인 치료가 필요하다. 대상 및 방법: 31세와 30세 남자 환자가 극심한 요통으로 응급실로 내원하였다. 31세 환자에서 Whitesides 방법을 이용하여 측정한 구획압은 35 mmHg 로 확인되었다. 30세 환자에서는 좌측에서 22 mmHg, 우측에서 30 mmHg로 측정되었다. 급성 요추부 척추 주위 근육의 구획 증후군으로 진단하고 근막절개술을 시행하였다. 결과: 근막 절개술 이후 혈액 검사는 호전되었다. 근막 피판술 후 수술 부위 상처도 회복되었다. 결론: 급성 요추부 척추 주위 근육의 구획 증후군은 매우 드물게 발생하지만 극심한 요통을 호소하는 환자의 경우에 고려되어야 한다. 약칭 제목: 급성 요추부 척추 주위 근육의 구획 증후군

The Effects of Different Types of High Heels and Walking Velocity on Muscle Activation of the Paraspinal Muscles

( Joong Sook Le ),( Dong Wook Han ) 대한물리의학회 2014 대한물리의학회지 Vol.9 No.3

PURPOSE : This study researched the effects of different types of high heels on the muscles surrounding the cervical spine, the thoracic spine, and the lumbar spine by analyzing muscle activation of the paraspinal muscles during walking while wearing high heels. The high heels were all of the same height: 8㎝. METHODS : The 28 subjects in this experiment were females in their 20s with a foot size of 225-230㎜. To measure the muscle activation of the paraspinal muscles, EMG electrodes were attached on the paraspinal muscles around C6, T7, and L5. The muscle activation during walking while wearing 8㎝ high wedge heels, setback heels, and french heels was measured. The measurements were performed 3 times each and the mean value of the result was used for analysis. Two kinds of velocity were used in this study. One of the velocity was 2.5 ㎧. The other was 3.5 ㎧. RESULTS : The muscle activation of paraspinal muscles increased significantly according to increase of walking velocity. But there was nosignificant difference according to the heel types. CONCLUSION : In view of the results, the height of heels and the velocity of walking are more convincing variables than the width of the heels on the muscle activation of paraspinal muscles. So wearing high heels is not recommended for those who have pain or functional problem of cervical and lumbar vertebrae.

Magnetic Resonance Imaging Assessment of Paraspinal Muscles in Dogs with Intervertebral Disc Herniation

Ye-Jin Kim,Ju-Yeong Kim,Ah-Won Sung,Hyun-Ju Cho,I-Se O,Ho-Jung Choi,이영원 한국임상수의학회 2022 한국임상수의학회지 Vol.39 No.6

A decrease in the paraspinal muscle cross-sectional area (CSA) and functional cross-sectional area (FCSA) are associated with low back pain and disc herniation in humans. This study examined whether chronicity or lateralization of disc herniation affects the CSA and FCSA of the paraspinal muscles. The CSA and FCSA of the paraspinal muscles between the 12th and 13th thoracic verte- brae were measured in 31 dogs with intervertebral disc herniation (IVDH). The muscle CSA and FCSA were evaluated by dividing the values of the body weight, spinal disc CSA, and spinal canal CSA to offset the differences in body type be- tween subjects. In the chronic IVDH group, the ratio of the paraspinal muscle CSA divided by the body weight was significantly lower, and fat infiltration in the paraspinal muscle was significantly higher than in the acute group. The lat- eralization of the disc herniation was significantly related to the changes in the paraspinal muscle CSA. In the right-sided disc herniation group, right epaxial muscle CSA was significantly reduced compared to the left-sided disc herniation group. The change in the paraspinal muscle might be a helpful indicator to local- ize less obvious disc pathologies and target the search for the pathology respon- sible for disc-related symptoms in dogs.

Paraspinal Muscle Sparing versus Percutaneous Screw Fixation: A Prospective and Comparative Study for the Treatment of L5-S1 Spondylolisthesis

Jang, Kun-Soo,Kim, Heyun-Sung,Ju, Chang-Il,Kim, Seok-Won,Lee, Sung-Myung,Shin, Ho The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.49 No.3

Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

Effect of Muscularity and Fatty Infiltration of Paraspinal Muscles on Outcome of Lumbar Interbody Fusion

You Ki-Han,Cho Minjoon,Lee Jae Hyup 대한의학회 2023 Journal of Korean medical science Vol.38 No.20

Background: Lumbar paraspinal muscles play an important role in maintaining global spinal alignment and are associated with lower back pain; however, only a few studies on the effect of the paraspinal muscles on the surgical outcome exist. Therefore, this study aimed to analyze the association of preoperative muscularity and fatty infiltration (FI) of paraspinal muscles with the outcome of lumbar interbody fusion. Methods: Postoperative clinical and radiographic outcomes were analyzed in 206 patients who underwent surgery for a degenerative lumbar disease. The preoperative diagnosis was spinal stenosis or low-grade spondylolisthesis, and the surgery performed was posterior lumbar interbody fusion or minimally invasive transforaminal lumbar interbody fusion. Indications for surgery were a complaint of severe radiating pain that did not improve with conservative treatment and neurological symptoms accompanied by lower extremity motor weakness. Patients with fractures, infections, tumors, or a history of lumbar surgery were excluded from this study. Clinical outcome measures included functional status, measured using the Oswestry disability index (ODI) and visual analog scale (VAS) score for lower back and leg pain. Other radiographic parameters included measures of spinal alignment, including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, C7 sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch. Lumbar muscularity (LM) and FI were measured preoperatively using a lumbar magnetic resonance image (MRI). Results: The high LM group showed more significant improvement in VAS score for lower back pain than the low LM group. In contrast, the VAS score for leg pain demonstrated no statistical significance. The high LM group showed more significant improvement in ODI postoperatively than the medium group. The severe FI group showed more significant improvement in ODI postoperatively, whereas the less severe FI group showed more significant improvement in the sagittal balance postoperatively. Conclusion: Patients with high LM and mild FI ratio observed on preoperative MRI demonstrated more favorable clinical and radiographic outcomes after lumbar interbody fusion. Therefore, preoperative paraspinal muscle condition should be considered when planning lumbar interbody fusion.

Changes of Paraspinal Muscles in Postmenopausal Osteoporotic Spinal Compression Fractures:Magnetic Resonance Imaging Study

김종윤,채수욱,김강득,차명수 대한골대사학회 2013 대한골대사학회지 Vol.20 No.2

Background: To investigate the changes of cross sectional area (CSA) in paraspinal mus-cles upon magnetic resonance imaging (MRI) and bone mineral density (BMD) in post-menopausal osteoporotic spinal compression fractures. Methods: We reviewed 81 post-menopausal women with osteoporosis, who had underwent MRI examination. The pa-tients were divided into 51 patients who had osteoporotic spinal compression fractures (group I), and 30 patients who without fractures (group II). Group I were subdivided into IA and IB, based on whether they were younger (IA) of older (IB) than 70 years of age. We additionally measured body mass index and BMD. The CSA of multifidus, erector spinae,paraspinal muscles, psoas major (PT), and intervertebral (IV) discs were measured. The degree of fatty atrophy was estimated using three grades. Results: The BMD and T-score of group I were significantly lower than those of group II. The CSA of erector spinae, para-spinal muscles, and PT in the group I was significantly smaller than that of group II. The CSA of paraspinal muscles in group IB were significantly smaller than those of group IA. The CSA of erector spinae, mutifidus, and PT in group IB were smaller than those of group IA, but the difference was not statistically significant. Group 1 exhibited greater fat infil-tration in the paraspinal muscle than group II. Conclusions: Postmenopausal osteopo-rotic spinal compression fracture is associated with profound changes of the lumbar paraspinal muscle, reduction of CSA, increased CSA of IV disc, and increased intramuscu-lar fat infiltration.

Back Muscle Changes after Pedicle Based Dynamic Stabilization

Moon, Kyung Yun,Lee, Soo-Eon,Kim, Ki-Jeong,Hyun, Seung-Jae,Kim, Hyun-Jib,Jahng, Tae-Ahn The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.3

Objective : Many studies have investigated paraspinal muscle changes after posterior lumbar surgery, including lumbar fusion. However, no study has been performed to investigate back muscle changes after pedicle based dynamic stabilization in patients with degenerative lumbar spinal diseases. In this study, the authors compared back muscle cross sectional area (MCSA) changes after non-fusion pedicle based dynamic stabilization. Methods : Thirty-two consecutive patients who underwent non-fusion pedicle based dynamic stabilization (PDS) at the L4-L5 level between February 2005 and January 2008 were included in this retrospective study. In addition, 11 patients who underwent traditional lumbar fusion (LF) during the same period were enrolled for comparative purposes. Preoperative and postoperative MCSAs of the paraspinal (multifidus+longissimus), psoas, and multifidus muscles were measured using computed tomographic axial sections taken at the L4 lower vertebral body level, which best visualize the paraspinal and psoas muscles. Measurements were made preoperatively and at more than 6 months after surgery. Results : Overall, back muscles showed decreases in MCSAs in the PDS and LF groups, and the multifidus was most affected in both groups, but more so in the LF group. The PDS group showed better back muscle preservation than the LF group for all measured muscles. The multifidus MCSA was significantly more preserved when the PDS-paraspinal-Wiltse approach was used. Conclusion : Pedicle based dynamic stabilization shows better preservation of paraspinal muscles than posterior lumbar fusion. Furthermore, the minimally invasive paraspinal Wiltse approach was found to preserve multifidus muscles better than the conventional posterior midline approach in PDS group.

무증상 한국 성인의 발근육과 허리엉치 척추옆 근의 탈신경 전위의 빈도

오주선,이베나,임정훈,송대헌,이원일 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1

Objective: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. Method: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. Results: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. Conclusion: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported.