Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology

Shahidi, Bahar; Hubbard, James C.; Gibbons, Michael C.; Ruoss, Severin; Zlomislic, Vinko; Allen, R. T.; Garfin, Steven R.; Ward, Samuel R.

doi:10.1002/jor.23597

Cited by 104 publications

(103 citation statements)

References 41 publications

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“…Despite the high proportion of markers for muscle recovery (centralized nuclei for regeneration and Pax7 + for satellite cell density), the number of muscle bers that exhibited degenerative characteristics remained high. This is consistent with previous results from our group that suggest the amount of muscle degeneration in chronic LBP patients outpaces the ability to restore a healthy muscle phenotype [10,63].…”

Section: Differences In Paraspinal Muscle Activation During Motion Ansupporting

confidence: 93%

“…Markers of muscle vascularity, damage, and degeneration did not signi cantly differ between super cial and deep samples Although the average percentage of centralized nuclei for each biopsy level was higher than expected for healthy skeletal muscle (3%), this percentage was lower than values reported for other studies examining lumbar spine pathology [10,11]. Despite the high proportion of markers for muscle recovery (centralized nuclei for regeneration and Pax7 + for satellite cell density), the number of muscle bers that exhibited degenerative characteristics remained high.…”

Section: Differences In Paraspinal Muscle Activation During Motion Ancontrasting

confidence: 69%

“…Microscopically, type II muscle ber atrophy, an increased proportion of glycolytic compared to oxidative muscle bers, decreased vascularity, elevated in ammatory cell count, increased numbers of centrally nucleated bers, and muscle ber degeneration has been observed in muscle biopsies obtained from individuals with chronic lumbar spine pathology [8][9][10][11]. Macroscopically, pathological changes in the multi dus of patients with LBP such as increases in intramuscular fat in ltration [3,10,12,13] and decreases in cross-sectional area ipsilateral to the side of reported pain [14] have been observed using magnetic resonance imaging (MRI) of the lumbar spine. Qualitatively, intramuscular fat in ltration appears to accumulate in the medial and deep regions of the multi dus in MRI, however regional in ltration of fat in the paraspinal muscles has not been quanti ed.…”

Section: Introductionmentioning

confidence: 99%

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Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

Padwal

Berry

Hubbard

et al. 2020

Preprint

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Background: Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology.Methods: In 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation. Results: No significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region. Conclusions: The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.

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Section: Differences In Paraspinal Muscle Activation During Motion Ansupporting

confidence: 93%

Section: Differences In Paraspinal Muscle Activation During Motion Ancontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

Padwal

Berry

Hubbard

et al. 2020

Preprint

Self Cite

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“…Most studies of PS FI center on imaging quantification of FI and correlation to clinical outcomes. Those that include histology of tissue have focused primarily on general muscle fiber architecture and SCs . Therefore, the literature on FAP populations within PS muscle and their contributions to FI are scant.…”

Section: Discussionmentioning

confidence: 99%

Rotator Cuff Fibro‐Adipogenic Progenitors Demonstrate Highest Concentration, Proliferative Capacity, and Adipogenic Potential Across Muscle Groups

Lee

Agha

Liu

et al. 2019

Journal Orthopaedic Research

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Fatty infiltration (FI) of rotator cuff (RC) muscles is common in patients with RC tears. Studies have demonstrated that fibro-adipogenic progenitors (FAPs), a population of resident muscle stem cells, are the main contributors of FI, which adversely affects muscle quality and RC repair success. Although FI is common in RC injuries, it is not frequently reported after other musculotendinous injuries. Additionally, studies have shown the development of different pathology patterns across muscle groups suggestive of intrinsic differences in cellular composition and behavior. This study evaluates FAP distribution and differentiation properties across anatomic locations in mice. Muscles from seven different anatomic locations were harvested from PDGFRα-eGFP FAP reporter mice. FAPs were quantified using histology and FACS sorting with BD Aria II with CD31 − /CD45 − /Integrinα7 − /Sca-1 + and PDGFRα reporter signal (n = 3 per muscle). The cells were analyzed for adipogenesis using immunocytochemistry and for proliferation properties with Brdu-Ki67 staining. In a separate group of mice, RC and tibialis anterior muscles received glycerol injection and were harvested after 2 weeks for FI quantification (n = 4). One-way analysis of variance was used for statistical comparisons among groups, with significance at p < 0.05. FAPs from the RC, masseter, and paraspinal muscles were more numerous and demonstrated greater proliferative capacity and adipogenic potency than those from the tibialis anterior and gastrocnemius. The RC demonstrated significantly greater levels of FI than the tibialis anterior after glycerol-injection injury. Clinical Significance: This study suggests differences in FAP distribution and differentiation characteristics may account for the propensity to develop FI in RC tears as compared with other musculotendinous injuries.

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“…Multifidus muscles biopsies were acquired from patients undergoing surgery. They concluded that changes in muscle tissue are more complex than simple atrophy including on average 48.5% muscle, 11.7% adipose tissue, and 26.1% collagen tissue, elevated inflammatory cells and decreased vascularity [22].…”

Section: Discussionmentioning

confidence: 99%

Paraspinal muscle hypotrophy and chronic discogenic low back pain

Truszczyńska-Baszak

Krauze

Tarnowski

2018

Biomedical Human Kinetics

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SummaryStudy aim: Low back pain is accompanied by deconditioning of trunk muscles due to pain limiting patients' physical activity, but so far it has not been explained whether the changes in the structure of muscles are the cause of disc disease or its result. The aim of the study was to analyze the prevalence of segmental paraspinal muscle hypotrophy in patients with chronic low back pain and sciatica. Material and methods:The study involved magnetic resonance imaging (MRI) of 40 patients: 20 women and 20 men aged from 30 to 47, mean 39.51 ± 3.73 years, with single level disc extrusion at L4-L5. The entire cross-sectional area of the paraspinal muscles, the adipose tissue area in the paraspinal muscles and the extensor muscle tissue area at the level of L4-L5 were measured and compared with the healthy L3-L4 level. T2-weighted axial slices were used to facilitate distinguishing between the muscle and the fat tissue. Results: Fat tissue ingrowth and paravertebral muscle tissue hypotrophy at the disc extrusion level were highly statistically significant (p < 0.001) compared to the healthy level. Conclusions: 1. Ingrowth of the adipose tissue into the muscle tissue occurs only at the level of disc extrusion. 2. It seems reasonable to introduce strengthening exercises after the resolution of pain in order to rebuild the muscles of the spine.

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Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology

Cited by 104 publications

References 41 publications

Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

Rotator Cuff Fibro‐Adipogenic Progenitors Demonstrate Highest Concentration, Proliferative Capacity, and Adipogenic Potential Across Muscle Groups

Paraspinal muscle hypotrophy and chronic discogenic low back pain

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