Fat infiltration in the multifidus muscle is related to inflammatory cytokine expression in the muscle and epidural adipose tissue in individuals undergoing surgery for intervertebral disc herniation

James, Gregory; Chen, Xiaolong; Diwan, Ashish D.; Hodges, Paul W.

doi:10.1007/s00586-020-06514-4

Cited by 47 publications

(63 citation statements)

References 27 publications

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“…Studies assessing the more chronic effects of experimental IVD injury through needle puncture in rabbits 111 and stab incision in sheep 114 found no histological signs of multifidus fatty infiltration 12 weeks after injury, 111 while Hodges et al 114 did find histological evidence of increased multifidus adipose and connective tissue, but not atrophy, 6 months following IVD injury. These latter histological findings were consistent with their gene expression data, showing increased expression of genes responsible for cytokines implicated in both adipogeneses and fibrosis 114 ; this upregulation of pro‐inflammatory gene expression is comparable to the findings from human patients with IVD herniation 38 and degenerative spine pathology 39,40 . The discrepancy in muscle atrophy findings between References 114 and 122 is not clear.…”

Section: Muscle Pathology In Lbpdssupporting

confidence: 82%

“…Numerous spine pathologies, including intervertebral disc (IVD) herniation, 17,18 sagittal balance disorder, 19–22 and nonspecific low back pain 12,23–25 are associated with paraspinal muscle adaptations; therefore, these muscle adaptations have been linked with a lowered quality of life for millions of patients annually 26–28 . Frequently reported muscle‐specific adaptations to spine pathology and low back pain include: lower muscle endurance 11,29,30 and lower muscle strength, 10,11,31 muscle atrophy, 17,23,24 fiber type changes, 26,32,33 increased intramuscular fat 24,34 and connective tissue, 18,35,36 distorted cell populations, 18,37 and altered gene expression 38–41 . It should be noted that reported findings from some of these studies are unable to compare to true controls (ie, asymptomatic patients) due to the invasive nature of paraspinal muscle biopsies required to make certain measurements; the details of these comparisons will be discussed throughout the main section of the text.…”

Section: Introductionmentioning

confidence: 99%

“… 26 , 27 , 28 Frequently reported muscle‐specific adaptations to spine pathology and low back pain include: lower muscle endurance 11 , 29 , 30 and lower muscle strength, 10 , 11 , 31 muscle atrophy, 17 , 23 , 24 fiber type changes, 26 , 32 , 33 increased intramuscular fat 24 , 34 and connective tissue, 18 , 35 , 36 distorted cell populations, 18 , 37 and altered gene expression. 38 , 39 , 40 , 41 It should be noted that reported findings from some of these studies are unable to compare to true controls (ie, asymptomatic patients) due to the invasive nature of paraspinal muscle biopsies required to make certain measurements; the details of these comparisons will be discussed throughout the main section of the text.…”

Section: Introductionmentioning

confidence: 99%

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Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders

Noonan

Brown

2021

JOR Spine

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Low back pain disorders affect more than 80% of adults in their lifetime and are the leading cause of global disability. The muscles attaching to the spine (ie, paraspinal muscles) are critical for proper spine health and play a crucial role in the functioning of the spine and whole body; however, reports of muscle dysfunction and insufficiency in chronic LBP (CLBP) patients are common. This article presents a review of the current understanding of the relationship between paraspinal muscle pathophysiology and spine‐related disorders. Human literature demonstrates a clear association between altered muscle structure/function, most notably fatty infiltration and fibrosis, and low back pain disorders; other associations, including muscle cell atrophy and fiber type changes, are less clear. Animal literature then provides some mechanistic insight into the complex relationships, including initiating factors and time courses, between the spine and spine muscles under pathological conditions. It is apparent that spine pathology can directly lead to changes in the paraspinal muscle structure, function, and biology. It also appears that changes to the muscle structure and function can directly lead to changes in the spine (eg, deformity); however, this relationship is less well studied. Future work must focus on providing insight into possible mechanisms that regulate spine and paraspinal muscle health, as well as probing how muscle degeneration/dysfunction might be an initiating factor in the progression of spine pathology.

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Section: Muscle Pathology In Lbpdssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders

Noonan

Brown

2021

JOR Spine

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“…Recent animal studies [ 55 ] have found that local inflammatory dysfunction is a new mechanism to explain fat and connective tissue accumulation in multifidus muscle during disc degeneration and injury. James examined whether there were differences in the expression of inflammatory genes in multifidus between individuals with low and high intramuscular fat content to test whether there was a similar mechanism in humans.…”

Section: Oxidative Stress and Inflammation Of Multifidusmentioning

confidence: 99%

Research Progress on the Mechanism of Lumbarmultifidus Injury and Degeneration

Wang

Jia

et al. 2021

Oxidative Medicine and Cellular Longevity

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This review summarizes recent research progress in the clinical features, image manifestations, and pathological mechanism of multifidus injury. After a brief introduction to the fiber classification, innervation, blood supply, and multifidus function, some factors of multifidus injury, consisting of denervation, intraoperative incision selection and traction, and lumbar degenerative disease are overviewed. In addition, the clinical index of multifidus injury including myoglobin, creatine kinase, IL-6, C-reactive protein, the cross-sectional area of multifidus, the degree of fat infiltration, and intraoperative biopsy are summarized. Furthermore, we recommend that patients with chronic low back pain should take the long-term exercise of lumbodorsal muscles. Finally, some remaining issues, including external fixation and the imaging quantitative evaluation criteria of multifidus, need to be further explored in the future.

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“…Multiple studies have shown that these muscles are dysfunctional in patients with low back pain, and in particular the multifidus has been shown to rapidly atrophy after acute episodes of pain ( 8 ). The mechanism behind this atrophy is believed to be the result of peripheral and centrally mediated inhibitory mechanisms, resulting in fatty infiltration and persistent inflammatory changes ( 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ). This leads to a deficit in involuntary muscle activation in response to perturbation and a loss of proprioceptive sensitivity ( 17 ), allowing the patient to adopt postures and motions that result in deviations from the safe range of motion ( 18 , 19 ), leading to additional injury and a negative feedback loop of further pain, disability, and muscular inhibition ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

Durability of the Therapeutic Effect of Restorative Neurostimulation for Refractory Chronic Low Back Pain

Mitchell¹,

Deckers

Smedt

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Objectives The purpose of the ongoing follow‐up of ReActiv8‐A clinical trial is to document the longitudinal benefits of episodic stimulation of the dorsal ramus medial branch and consequent contraction of the lumbar multifidus in patients with refractory mechanical chronic low back pain (CLBP). We report the four‐year outcomes of this trial. Materials and Methods ReActiv8‐A is a prospective, single‐arm trial performed at nine sites in the United Kingdom, Belgium, and Australia. Eligible patients had disabling CLBP (low back pain Numeric Rating Scale [NRS] ≥6; Oswestry Disability Index [ODI] ≥25), no indications for spine surgery or spinal cord stimulation, and failed conventional management including at least physical therapy and medications for low back pain. Fourteen days postimplantation, stimulation parameters were programmed to elicit strong, smooth contractions of the multifidus, and participants were given instructions to activate the device for 30‐min stimulation‐sessions twice daily. Annual follow‐up through four years included collection of NRS, ODI, and European Quality of Life Score on Five Dimensions (EQ‐5D). Background on mechanisms, trial design, and one‐year outcomes were previously described. Results At baseline (N = 53) (mean ± SD) age was 44 ± 10 years; duration of back pain was 14 ± 11 years, NRS was 6.8 ± 0.8, ODI 44.9 ± 10.1, and EQ‐5D 0.434 ± 0.185. Mean improvements from baseline were statistically significant (p < 0.001) and clinically meaningful for all follow‐ups. Patients completing year 4 follow‐up, reported mean (±standard error of the mean) NRS: 3.2 ± 0.4, ODI: 23.0 ± 3.2, and EQ‐5D: 0.721 ± 0.035. Moreover, 73% of participants had a clinically meaningful improvement of ≥2 points on NRS, 76% of ≥10 points on ODI, and 62.5% had a clinically meaningful improvement in both NRS and ODI and 97% were (very) satisfied with treatment. Conclusions In participants with disabling intractable CLBP who receive long‐term restorative neurostimulation, treatment satisfaction remains high and improvements in pain, disability, and quality‐of‐life are clinically meaningful and durable through four years.

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Fat infiltration in the multifidus muscle is related to inflammatory cytokine expression in the muscle and epidural adipose tissue in individuals undergoing surgery for intervertebral disc herniation

Cited by 47 publications

References 27 publications

Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders

Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders

Research Progress on the Mechanism of Lumbarmultifidus Injury and Degeneration

Durability of the Therapeutic Effect of Restorative Neurostimulation for Refractory Chronic Low Back Pain

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