Computed tomography evaluation of fat infiltration ratio of the multifidus muscle in chronic low back pain patients

Prasetyo, Marcel; Nindita, Nadia; Murdana, I Nyoman; Prihartono, Joedo; Setiawan, Stefanus Imanuel

doi:10.1016/j.ejro.2020.100293

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…To evaluate the quality of the lumbar muscles, fat infiltration (FI), CT and MRI are commonly utilized. Although MRI is more commonly used, several previous studies have used CT for the evaluation of FI and reported the reliability of CT evaluation [6][7][8][9]. The CSA and FI of the lumbar muscles are associated with age, sex, body mass index (BMI), and LBP [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The Quantity and Quality of Lumbar Muscles and Lumbopelvic Parameters in Patients With Degenerative Spondylolisthesis

Ohyama¹,

Aoki²,

Inoue³

et al. 2021

Cureus

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IntroductionLumbar degenerative spondylolisthesis (DS) is one of the most common causes of low back pain. The lumbar muscles, such as the psoas major (PM), erector spinae (ES), and multifidus (MF) muscles, play an important role in the stability and functional movement of the lumbar spine. The quantities and qualities of these muscles may be related to the occurrence of DS and lumbopelvic parameters, such as lumbar lordosis (LL) and sacral slope (SS). However, the influence of lumbar muscles on DS and lumbopelvic alignment is not well understood. MethodsPatients with L4 DS (DS group, n=25) and without DS (non-DS group, n=25) were included. Using sagittal reconstructed CT images of patients who visited our hospital for reasons other than low back disorders, LL, upper lumbar lordosis ([ULL] L1-L4), lower lumbar lordosis ([LLL] L4-S1), and SS were examined. To evaluate the quantity and quality of lumbar muscles, the gross cross-sectional area (GCSA), functional cross-sectional area (FCSA), and fat infiltration (FI) of the PM, ES, and MF muscles were measured by CT images. The lumbopelvic parameters, FCSA, GCSA, and FI of lumbar muscles were compared between the two groups. Then, each lumbar muscle parameter was analyzed for correlation with DS and lumbopelvic parameters. ResultsDS patients displayed significantly greater ULL and lower FI of the PM and ES muscles than non-DS patients (p=0.0078, 0.031, and 0.010, respectively). The FI of the ES muscle was significantly correlated with the presence of DS (p=0.010). The FCSA of the ES and MF muscles and the GCSA of the MF muscle showed a significant correlation with LL and SS in the non-DS group (p<0.05), but not in the DS group.. ConclusionULL was greater in L4 DS patients, possibly related to the better quality of the ES muscle. All DS patients showed mild (grade I) spondylolisthesis, suggesting the possibility that lumbar muscle quality is better in patients with mild DS than in those without DS. The ES and MF muscles may play an important role in maintaining the lumbar lordotic angle in non-DS patients but not in DS patients.

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Section: Introductionmentioning

confidence: 99%

The Quantity and Quality of Lumbar Muscles and Lumbopelvic Parameters in Patients With Degenerative Spondylolisthesis

Ohyama¹,

Aoki²,

Inoue³

et al. 2021

Cureus

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“…The multifidus is important as it provides segmental stability and functions as a dynamic stabilizer of the lumbar spine. 3 Previous studies 4,5 showed a significant increase in the cross--sectional area of the multifidus muscle after eight weeks of spinal stabilization exercise compared to the pre-exercise status. It is generally believed that muscular insufficiency and LBP are related, although the primary direction of this relationship is unclear.…”

Section: Introductionmentioning

confidence: 90%

“…1,2 Examination of the total cross-sectional area of the multifidus muscle using Magnetic Resonance Imaging (MRI) has been used to assess the effectiveness of selective spinal stabilization exercises in patients with chronic low back pain (LBP). 3 The role of the paraspinal muscles in the origin of LBP remains unclear. [1][2][3][4][5] There are indications that the multifidus muscles are susceptible to the different pathologies in LBP.…”

Section: Introductionmentioning

confidence: 99%

“…3 The role of the paraspinal muscles in the origin of LBP remains unclear. [1][2][3][4][5] There are indications that the multifidus muscles are susceptible to the different pathologies in LBP. [6][7][8] However, it is not known whether atrophy of the paravertebral muscles is a cause or a result of the different pathological processes of LBP.…”

Section: Introductionmentioning

confidence: 99%

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Correlation Between Low Back Pain Due to Fatty Degeneration and Sex and Age: Study by Mri

2021

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Objective: To correlate low back pain caused by fatty degeneration, visualized by magnetic resonance imaging (MRI), with sex and age. Methods: With a timeframe of 2015 to 2020, data on sex and age of fifty symptomatic patients with low back pain were collected from medical records and correlated with MRI analyses showing the occurrence of fatty infiltration in the paraspinal and erector muscles. Three trained observers, using the classification of Goutallier et al. (1994), analyzed five lumbar levels and the degree of injury. The Kolmogorov-Smirnov, Shapiro Wilk, Student's t, Mann-Whitney and Spearman correlation tests were used, all with a 5% significance level. Results: Among the cases, the L5-S1 level was found in all the images, with a prevalence of 46% of grades 1 and 2 and 24% in the five lumbar levels. Severity was present in a small portion (8%) of the injuries. There was a predominance of 78% women, with significantly more severe injuries in relation to the number of levels (p < 0.001) and injuries of a higher degree (p < 0.001). The age range was 14 to 38 years (mean = 26.70 ± 5.70 years), showing a significant and moderate correlation between the number of levels reached and a greater degree of degeneration (p < 0.001). Conclusion: Fatty degeneration as a cause of low back pain was significantly more severe in women in terms to the number of levels and the higher degree of injury. The number of levels and the severity of fatty degeneration were not correlated with the patient's age. Level of evidence II; Retrospective Study.

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“…Infiltration of muscle with fat is well-known to indicate decreased muscle quality. This can be observed with CT, with fat-infiltrated muscle demonstrating decreased attenuation as compared to non-fatty muscle ( Prasetyo et al, 2020 ). However, this attenuation is not specific to the most metabolically significant fat component, IMCL.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Intramyocellular Lipids to Decreased Computed Tomography Muscle Density With Age

Brennan¹,

Fishbein²,

Reiter³

et al. 2021

Front. Physiol.

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Skeletal muscle density, as determined by computed tomography (CT), has been shown to decline with age, resulting in increased frailty and morbidity. However, the mechanism underlying this decrease in muscle density remains elusive. We sought to investigate the role of intramyocellular lipid (IMCL) accumulation in the age-related decline in muscle density. Muscle density was measured using computerized tomography (CT), and IMCL content was quantified using in vivo proton magnetic resonance spectroscopy (1H-MRS). The study population consisted of 314 healthy participants (142 men, 32–98 years) of the Baltimore Longitudinal Study of Aging (BLSA). In addition to IMCL quantification, obesity-related covariates were measured, including body mass index (BMI), waist circumference, and circulating triglyceride concentration. Higher IMCL concentrations were significantly correlated with lower muscle density in older individuals, independent of age, sex, race, and the obesity-associated covariates (p < 0.01). Lower muscle density was also significantly associated with greater age-adjusted IMCL, a variable we constructed using LOESS regression (p < 0.05). Our results suggest that the accumulation of IMCL may be associated with a decrease in muscle density. This may serve to define a potential therapeutic target for treatment of age-associated decreased muscle function.

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Computed tomography evaluation of fat infiltration ratio of the multifidus muscle in chronic low back pain patients

Cited by 12 publications

References 29 publications

The Quantity and Quality of Lumbar Muscles and Lumbopelvic Parameters in Patients With Degenerative Spondylolisthesis

The Quantity and Quality of Lumbar Muscles and Lumbopelvic Parameters in Patients With Degenerative Spondylolisthesis

Correlation Between Low Back Pain Due to Fatty Degeneration and Sex and Age: Study by Mri

Contribution of Intramyocellular Lipids to Decreased Computed Tomography Muscle Density With Age

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