Paravertebral injection of botulinum toxin‐A reduces lumbar vertebral bone quality

Abstract

Aging has been associated with decreases in muscle strength and bone quality. In older patients, paravertebral muscle atrophy tends to coincide with vertebral osteoporosis. The purpose of this study was to investigate the effects of a paravertebral injection of botulinum toxin-A (BTX) on paravertebral muscle atrophy and lumbar vertebral bone quality. Forty 16-week-old female SD rats were randomly divided into four groups: (1) a control group (CNT); (2) a resection of erector spinae muscles group (RESM); (3) a botulinum toxin-A group (BTX), treated with 5U BTX by local injection into the paravertebral muscles bilaterally; and (4) a positive control group (OVX), treated by bilateral ovariectomy. Rats were sacrificed at 12 weeks post-surgery, and the lumbar vertebrae (L3-L6) were collected. Micro-CT scans showed that rats in the three experimental groups-particularly the OVX rats-had fewer trabeculae and trabecular connections than rats in the CNT group. BMD was significantly lower in rats in the OVX, RESM, and BTX groups than in the CNT group (p < 0.01). Vertebral compression testing revealed significantly lower maximum load, energy absorption, maximum stress, and elastic modulus values in the three experimental groups compared with the CNT group (p < 0.01); these parameters were lowest in the OVX group (p < 0.05). Our results demonstrate that local BTX injection causes sufficient muscle atrophy and dysfunction to result in local lumbar vertebral bone loss and quality deterioration in a model of paravertebral muscle atrophy. Clinical Significance: The muscular tissues surrounding the lumbar vertebrae should be preserved during clinical surgery to avoid loss of bone quality and mass in the adjacent bone. Maintaining paravertebral muscle strength is an important consideration for patients with early osteoporosis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2664-2670, 2018.

Clinical use of quantitative computed tomography to evaluate the effect of less paraspinal muscle damage on bone mineral density changes after lumbar interbody fusion

“…Several studies have shown a strong association between fatty infiltration of the multifidus muscle and lumbar BMD [ 25 , 26 ]. Wang et al [ 13 ] conducted an experimental study in rats and found that bone loss occurred in rats with paraspinal muscular atrophy compared with that in controls. They concluded that preserving the muscle tissue around the lumbar spine during clinical surgery was important to prevent the loss of lumbar spine bone quality and mass [ 13 ].…”

“…Wang et al [ 13 ] conducted an experimental study in rats and found that bone loss occurred in rats with paraspinal muscular atrophy compared with that in controls. They concluded that preserving the muscle tissue around the lumbar spine during clinical surgery was important to prevent the loss of lumbar spine bone quality and mass [ 13 ]. Jin et al [ 27 ] found that skeletal muscle satellite cells that adhere to muscle fibers play a crucial role in the repair of osteoporotic fractures, maintaining their differentiation into osteoblasts and restricting osteoclastogenesis through the β-catenin signaling pathway.…”

“…Studies have consistently demonstrated a significant correlation between lumbar BMD and paraspinal muscles [ 11 , 12 ]. A study conducted on rats revealed that preserving the muscle tissue surrounding the lumbar spine during surgical procedures may help prevent loss of bone quality and mass in adjacent areas [ 13 ]. Therefore, we hypothesized that reducing intraoperative paraspinal muscle destruction may play an important role in preserving the BMD in patients who have undergone lumbar interbody fusion.…”

Rheumatoid Arthritis Induced by Botulinum Toxin Type A: A Case Report and Review of the Literature

“…For example, BoNT/Ainduced masticatory muscle atrophy can promote mandibular loss [23]. Wang et al also discovered that injecting BoNT/A into paraspinal muscles could lead not only to muscle atrophy and dysfunction, but also to local bone loss and quality loss of the lumbar spine [24].…”