Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain

Abstract

Background Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. Methods A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. Results There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07–8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/− 13.19% for L4/L5 and a higher mean value of 26.37+/− 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. Conclusion The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.

Is there a correlation between upper lumbar disc herniation and multifidus muscle degeneration? A retrospective study of MRI morphology

“…Certain studies have reported that the degree of fatty infiltration of multifidus muscle at the same level as the ipsilateral segment of the LDH was significantly higher than on the contralateral segment. These findings confirmed the feasibility and reliability of visually evaluating the degree of fatty infiltration of multifidus muscle [ 6 , 14 , 17 , 26 ]. Additionally, it was also reported that compared to assessing the cross-sectional area in patients with lumbar disc herniation, it was much more effective to assess the degree of multifidus fatty infiltration [ 27 ].…”

“…Faur et al reported that multifidus muscle degeneration primarily occurred along the cross-section of MRI scans. Additionally, they reported that the degree of multifidus muscles degeneration was proportional to the degree of disc degeneration [ 26 ]. In this study, the patients with ULDH are significantly different from healthy people in the measurement indexes of the multifidus muscles.…”

Comparison of Pain, Multifidus Muscle Volume, Depression and Functional Level in Bulging and Protruded Lumbar Disc Herniation

“…farklı seviyelerdeki disk dejenerasyonlu hastalarda en fazla atrofinin L5-S1 seviyesi lomber multifidus kasında olduğunu göstermişlerdir. 29 Biz de bu çalışmada L5-S1 seviye lomber disk hernisi tanılı akut bel ağrılı hastalarda lomber multifidus kasının kesit alanı bilateral olarak inceledik. Farklı çalışmalarda multifidus kesit alanları unilateral olarak hesaplanmasına karşın çalışma grubumuzdaki hastaların akut evre olması ve yaygın bel ağrısı tanımlaması sebebiyle MRG hesaplamaları, bilateral ölçüm toplamı alınarak yapıldı.…”

“…çalışmalarında kronik evrede farklı seviyedeki disk dejenerasyonlarıyla lomber multifidus kas atrofisi arasında düşük bir ilişki olduğunu da göstermişlerdir. 29 Ancak çalışmamızdan farklı olarak bu çalışma kronik evredeki bulging, protrüzyon, ekstrüzyon ve sekestrasyon evre disk hernili hastalar üzerinde yapılmış ve en büyük atrofi, kronik ve ilerlemiş disk hernilerinde bulunmuştur. Boyacı ve ark.…”

Lomber Disk Cerrahisinde İnsizyon Büyüklüğünün Ameliyat Sonrası Paraspinal Adale İyileşmesine Etkisi

“…ise LMK ile lomber disk dejenarasyonu arasındaki ilişki olduğunu göstermişlerdir. LMK atrofisinin alt lomber bölgede daha yüksek olduğunu ve dejenerasyon arttıkça atrofininde de arttığını gözlemlemişlerdir(22). Başka bir çalışmada her ne kadar klinik sonuçları bilinmese de, postoperatif 1. gündeki CK seviyelerinin MED ve açık diskektomi arasında kıyasladığında, MED grubunda kas atrofisi sonuçlarının daha iyi olduğu gözlenmiştir(30).…”