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.

Effects of Seated Exercise of Thoracic and Abdominal Muscles on Upper Extremity Function and Trunk Muscles Activity in Patients with Chronic Stroke

Shinjun Park,Sangduk Kim 국제물리치료연구학회 2020 Journal of International Academy of Physical Ther Vol.11 No.2

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

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.

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.

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.

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.

Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model

Luis Alberto Ortega-Porcayo,Andres Leal-López,Miroslava Elizabeth Soriano-López,Carlos Francisco Gutiérrez-Partida,Luis Rodolfo Ramírez-Barrios,Sergio Soriano-Solis,Manuel Rodríguez-García,Hector Anto 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective comparative clinical study. Purpose: This study aimed to assess paraspinal muscle atrophy in patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and unilateral pedicle screw fixation using a novel contralateral intact muscle-controlled model. Overview of Literature: The increased incidence of paravertebral lumbar muscle injuries after open techniques has raised the importance of implementing minimally invasive spine surgical techniques using tubular retractors and minimally invasive screw placement. The functional cross-sectional area (FCSA) represents the lean muscle mass; furthermore, FCSA is a useful marker of the contractile ability of a muscle following a spine surgery. However, the benefits of unilateral fixation and MI-TLIF on paraspinal muscles have not been defined. Methods: We performed a retrospective imagenological review on eleven patients who underwent unilateral MI-TLIF and unilateral transpedicular screw lumbar placement. FCSAs of the multifidus and erector spinae were measured 1 year after surgery at adjacent levels and were compared to the contralateral intact muscles. Measurement differences between the surgical and nonsurgical sites were compared. The interobserver reliability was calculated using an intraclass correlation coefficient. Results: The mean FCSA at the surgical site was 20.97±5.07 cm2 at the superior level and 8.89±2.87 cm2 at the inferior level. The mean FCSA at the contralateral nonsurgical site was 20.15±5.95 cm2 at the superior level and 9.20±2.66 cm2 at the inferior level was. The superior and inferior FCSA measurements showed no significant difference between the surgical and nonsurgical sites (p =0.5, p =0.922, respectively). Conclusions: Using a mini-open tubular approach through the sulcus between the longissimus and iliocostalis, MI-TLIF and unilateral pedicle screw instrumentation produced minimal paraspinal muscle damage at the superior and inferior adjacent levels.

급성 및 만성 요통환자의 요부주위근 횡단면적과 요통 예후의 상관관계 연구

남지환,이종환,이슬지,김기원,이민정,전재윤,임수진,홍남중,송주현 대한침구의학회 2013 대한침구의학회지 Vol.30 No.4

Objectives : The purpose of this study was to evaluate the relationship between cross-sectional areas of the paraspinal and psoas muscles with low back pain. Methods : We assessed the cross-sectional area of the psoas and paraspinal muscles at the superior part of L4 level and vertebral body of L4 of 132 patients who were hospitalized with a chief complaint of low back pain at Jaseng Hospital of Korean Medicine from January 2013 to April 2013. After calculating the mean psoas area, we divided the patients into 2 groups by whether the psoas cross section was larger or smaller than the mean, and compared the admission period, verbal numeric rating scale(NRS) of low back pain(LBP), and improvement of verbal NRS of LBP. We also subcategorized the patients into acute and chronic groups according to the duration period, and compared the cross-sectional area of the psoas and paraspinal muscles. Results : Although analyses of the verbal NRS of LBP, and improvement of verbal NRS of LBP between groups with larger and smaller psoas cross section areas showed no significant difference, the admission period was significantly shorter in the group with larger psoas cross section areas. There was no significant difference in analyses of cross section areas in the acute and chronic groups. Of the possible prognostic variables, improvement of verbal NRS of LBP showed no correlation, while the admission period displayed a significant correlation. The cross-sectional area of the psoas and paraspinal muscles divided by the area of the vertebral body of L4 had a significant negative correlation with age. Conclusions : The cross-sectional area of the psoas and paraspinal muscles were correlated with the admission period in LBP patients, and the cross-sectional area of the surrounding muscles divided by the area of the L4 vertebral body was negatively correlated with age.

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.

척추전방전위증 환자 45예의 요추주변근육의 지방침착도와 전위정도의 상관성에 대한 후향적 연구

김유곤 ( Yu-gon Kim ),김대호 ( Dae-ho Kim ),정현교 ( Hyeon-gyo Jeong ),임진웅 ( Jin-woong Lim ),김용화 ( Yong-hwa Kim ),강덕 ( Deok Kang ),정회준 ( Hwe-joon Jeong ),신경문 ( Kyung-moon Shin ),신동훈 ( Dong-hoon Shin ),양재우 ( Ja 한방재활의학과학회 2022 한방재활의학과학회지 Vol.32 No.1

Objectives Objective of this study is to investigate the role of paraspinal muscles by examining the correlation between slip percentage (SP) of spondylolisthesis and fatty infiltration of lumbar paraspinal muscle. Methods Retrospective analysis was performed on 45 patients diagnosed with spondylolisthesis based on medical records. Using T2-weighted axial magnetic resonance imaging, cross-sectional areas (CSAs) of psoas major (PM), multifidus (MU) and erector spinae (ES) were calculated and divided by CSA of lower level vertebral body (VB). SP was measured using sagittal T2-weighted images. Correlation of SP with muscle relative cross-sectional area (RCSA) and muscle fatty infiltration by Goutallier classification was respectively analyzed using Spearman correlation. Statistic assessment conducted by Wilcoxon signed rank test and paired t-test using program GraphPad prism 5 (GraphPad Software, Inc., San Diego, CA, USA). Results Spondylolisthesis forward slip percentage by Taillard's method was negatively associated with both side MU RCSAs. No significant correlation was found between PM RCSA, ES RCSA and SP. Forward slippage was significantly correlated with fatty infiltration of lumbar paraspinal muscle measured by Goutallier classification. Conclusions This study is to understand the role of paraspinal muscle affecting spinal instability by investigating correlation between statistical deviation of lumbar muscle characters (RCSA, fatty infiltration of lumbar muscle) and SP. We found that spondylolisthesis SP is positively related to fatty infiltration of lumbar paraspinal muscle. and is negatively associated with both side MU RCSAs. (J Korean Med Rehabil 2022;32(1): 51-62)