Internal lumbar disc derangement with instability catch from monosegmental discopathy. The forgotten mechanical and kinetic surgical back pain syndrome

Bednar, Drew A.; Bednar, E Dimitra

doi:10.1016/j.clineuro.2021.107033

Cited by 1 publication

(4 citation statements)

References 27 publications

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“…7,8 Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles were considered as the possible origins of LBP. [9][10][11][12][13][14][15][16][17] However, patients with LBP and asymptomatic subjects did not differ in prevalence of IVDD and Modic changes. 18,19 Even though parasinal muscles are the main stabilizers of the lumber spine, most of the previous studies did not focus on paraspinal muscles.…”

mentioning

confidence: 79%

“…Spine studies have focused on IVDD and Modic changes rather than paraspinal muscles until the recent decade. [12][13][14][15][16][17][18][19]21 It has been reported that multifidus could be the source of LBP in symptomatic subjects. 29 However, studies comparing the symptomatic and matched asymptomatic subjects were rare.…”

Section: Discussionmentioning

confidence: 99%

“…Spine studies have focused on IVDD and Modic changes rather than paraspinal muscles until the recent decade 12–19,21 . It has been reported that multifidus could be the source of LBP in symptomatic subjects 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies focused on the pathogenesis of LBP 7,8 . Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles were considered as the possible origins of LBP 9–17 . However, patients with LBP and asymptomatic subjects did not differ in prevalence of IVDD and Modic changes 18,19 .…”

Section: Introductionmentioning

confidence: 99%

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Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain

Ekşi,

Özcan‐Ekşi

2023

Pain Practice

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PurposeIntervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end‐plates, and fatty infiltration in their paraspinal muscles.MethodsConsecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age‐, gender‐ and BMI‐matched asymptomatic controls.ResultsLow back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels.ConclusionSevere IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.

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