Feasibility assessment of shear wave elastography to lumbar back muscles

Abstract

Low back pain is often associated with tensional changes in the paraspinal muscles detected by palpatory procedures. Shear wave elastography (SWE), recently introduced, allows the stiffness of muscles to be assessed noninvasively. The aim of this work was to study the feasibility of using SWE on the three main lumbar back muscles (multifidus, longissimus, and iliocostalis) in vivo after analyzing their muscular architecture ex vivo. We determined the orientation of fibers in the multifidus, longissimus, and iliocotalis muscles in seven fresh cadavers using gross anatomy and B-Mode ultrasound imaging. We then quantified the stiffness of these three muscles at the L3 level ex vivo and in 16 healthy young adults. Little pennation was observed in the longissimus and iliocostalis, in which the direction of fibers was almost parallel to the line of spinous processes. The multifidus appeared as a multiceps and multipennate muscle. Given the random layering of millimetric fascicles, tendons, and fatty spaces, the multifidus had multiple fiber orientations. Muscular fascicles and fibers were oriented from 9° to 22° to the line of spinous processes. The shear moduli related to stiffness were 6.9 ± 2.7 kPa for the longissimus, 4.9 ± 1.4 kPa for the iliocostalis, and 5.4 ± 1.6 kPa for the multifidus. SWE is a feasible method for quantifying the stiffness of the lumbar back muscles. Clin. Anat. 30:774-780, 2017. © 2017Wiley Periodicals, Inc.

Influence of thoracolumbar fascia stretching on lumbar back muscle stiffness: A supersonic shear wave elastography approach

“…In accordance with prior findings, ES exhibited significant greater stiffness than multifidus in all postures (Creze et al, ; Creze et al, ). Multifidus exhibited proportionally greater stiffness changes from procubitus to seated position.…”

“…Regarding the multifidus stiffness value, our findings are lower than those of previous studies using SWE and strain elastography (Chan et al, ; Moreau et al, ; Creze et al, ; Dieterich et al, ; Koppenhaver et al, ). Earlier reports found greater stiffness in ES resting than in our study (Kelly et al, ; Koppenhaver et al, ).…”

“…Earlier reports found greater stiffness in ES resting than in our study (Kelly et al, ; Koppenhaver et al, ). Given the intramuscular stiffness variability, the difference of anatomical landmarks chosen for probe position and stiffness analysis may have resulted in conflicting findings (Creze et al, ). Differences in methodological approaches such as probe, scanner preset, ROI size, ROI position and body position (through muscle stretching or torque) to assess stiffness have been identified as factors influencing stiffness measurements (Ewertsen et al, ).…”

“…Because of the difficulty to achieve the complex anatomy of the LPM, which are polyarticular, multiceps and multipennate muscles, only few studies have been conducted on the LPM stiffness (Winckler, ; Macintosh and Bogduk, , ; Bogduk et al, ; Creze et al, ; Kelly et al, ). Stiffness value of the LPM and reproducibility of SWE in the LPM depend on various factors including stretching, torque, contraction, compression of the TLF and posture (Koppenhaver et al, ; Moreau et al, ).…”

Magnetic resonance elastography of the lumbar back muscles: A preliminary study

“…In LPM, only shear wave sonoelastography (SWE) and strain sonoelastography have been used to date. The mean SM of the multifidus was 8.5 kPa and 5.4 kPa using SWE (Creze et al, ). Using strain elastography, Chan et al () found a mean Young's modulus of 36.4 kPa (corresponding to SM = 12 kPa).…”