The effect of paraspinal muscles on the lumbar disc herniation

Abstract

T he lumbar disc degeneration is very common problem among patients. Patients with this problem are diagnosed usually with the symptom of low back pain (LBP) which is followed by lumbar MRI (magnetic resonans imagination). [1,2] During the evaluation of a lumbar MRI the changes in the paraspinal muscles (PSM) are usually overlooked in clinical routine. The diagnosis of disc herniation has been associated with many factors in the literature such as body weight, height and high body mass index (BMI). [3][4][5][6] Lumbar PSM is composed of iliocostalis, longissimus and spinalis called PS errector muscle group and multifidus muscle. The PSM support the spine, maintain posture, and assist in trunk movements. Their funtion of postural control and lumbar movement perception is very important in stabilization of disc herniation. The role of PSM in hernia formation have not been questioned directly.[7-10] However, there have been many studies relating the paraspinal muscles atrophy, asymmetry, or fatty infiltration to the LBP problems. [7][8][9][11][12][13][14][15][16][17] Here, we presented a multiparameter involved complex study which analysed the hernia grading, bilateral PSM muscle lengths, and BMI. Materials and MethodsSeventy patients 40 (58%) females and 30 (42%) males, age range 30-50; mean age 47.2±13.5 years were studied. The lumbar MRI of LBP patients from the records of Radiology Objectives: Lumbar disc degeneration is diagnosed with radiological signs in the paraspinal muscles (PSM) seen on lumbar magnetic resonance imaging. It is associated with body weight, height, and a high body mass index (BMI). The role of the PSM has not been examined in the literature. The aim of this study was to analyze hernia grading, bilateral PSM length, and BMI. Methods: The grading of herniation size and the anteroposterior (AP) length of the bilateral PSM and their distance to the skin was assessed at lumbar intervertebral levels in 70 patients with low back pain. Data collected were the bilateral AP lengths of the psoas and PS erector muscle group, Modic type endplate degeneration, and hernia grade at each intervertebral level from L1 to S1. Patients' age, sex, and BMI were also recorded. Results: The hernia grades 0-1 were common at the L1-L2, L2-L3, and L3-L4 levels with statistical significance, and hernia grades 2-3 were common at the L4-L5 and L5-S1 levels. The mean age of the patients with a normal BMI was lower than that of the patients who were overweight or obese. The mean age was associated with hernia grade only at the L2-L3 and L3-L4 levels, and it was also related to the right side AP length of the PSM at the L2-L3 and bilateral psoas to skin distance at L3-L4. BMI was not associated with any AP length of bilateral PSM except at the L5-S1 level. There was a correlation between hernia grade 0 and AP length of the right PSM at the L2-L3 level and the left PSM at the L4-L5 level. Conclusion: PSM atrophy was not related to the severity of hernia or pain, and control of BMI may be effective for hernia. Further studie...