Evaluation of the degeneration of the multifidus and erector spinae muscles in patients with low back pain and healthy individuals

Abstract

BACKGROUND: Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE: The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals. METHODS: The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+LES), fat infiltrations and asymmetries. RESULTS: The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p< 0.001, p= 0.002, p= 0.002, p= 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p= 0.007, p< 0.001, p= 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION: A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.

The impact of protrusion size on pain, range of motion, functional capacity, and multifidus muscle cross-sectional area in lumbar disc herniation

“…A study aligned with our perspective emphasized the importance of incorporating measurements of muscle atrophy related to fat infiltration or functional cross-sectional area (CSA) to obtain a more precise evaluation of muscle mass. [29] Indeed, another study conducted by the same authors demonstrated that fat infiltration exhibited a significant correlation with root compression, and the severity of fat filtration further escalated when root compression was present. [15] In our study, in which the multifidus cross-sectional area was calculated in patients with nerve compression, we found that the amount of protrusion had no effect on the cross-sectional area of the lumbar multifidus muscle.…”

“…A study aligned with our perspective emphasized the importance of incorporating measurements of muscle atrophy related to fat infiltration or functional cross-sectional area (CSA) to obtain a more precise evaluation of muscle mass. [29]…”