Lumbar Paraspinal Muscles Research Articles

요추 주변 근육 단면적과 척추전방전위증의 상관성에 대한 후향적 연구

Objectives To investigate correlation between slip percentage (SP) of spondylolisthesis and cross-sectional area (CSA) of lumbar paraspinal muscles; psoas major (PM), multifidus (MU) and erector spinae (ES). Methods A retrospective study was carried out in 120 spondylolisthesis patients who had visited the Spine center of Kyung Hee University Hospital at Gangdong and had taken lumbar MRI. CSA of lumbar paraspinal muscles was measured from axial T2-weighted MRI and divided by CSA of vertebral body to avoid weight`s influence. SP was also measured from sagittal MRI. Results SP increase has significant correlation with decreased CSA-MU (r

Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases.

OBJECTIVE The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements. METHODS The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy). RESULTS Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p < 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039). CONCLUSIONS Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar PSMs, whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of IS.

New Predictive Index for Lumbar Paraspinal Muscle Degeneration Associated With Aging.

A cross-sectional imaging study of paraspinal muscle degeneration using a new index for easy evaluation. To examine the natural progression of age-related changes in the lumbar paraspinal muscles and to verify the validity of our new index for evaluating paraspinal muscle degenerationSUMMARY OF BACKGROUND DATA.: Measurement of paraspinal muscle morphology is an effective method for reflecting atrophy and fat infiltration, but it is complicated to perform. Therefore, we focused on the groove between lumbar paraspinal muscles as a simple index for evaluating paraspinal muscle degeneration. A total of 160 subjects aged 10 to 88 years (10 male and 10 female subjects in each decade) with lumbar lordosis of more than 20° were included. Body mass index (BMI) was calculated. Sagittal T2-weighted magnetic resonance imaging (MRI) was used to measure lumbar lordosis, while axial T2-weighted MRI was used to measure cross-sectional area (CSA) and fat infiltration rate of the paraspinal muscles at the intervertebral disc level from L1 to L5. To quantify the depth of the groove between the paraspinal muscles, our own image index (lumbar indentation value (LIV): equal to the length of the bulge of the muscle to the attachment of the spinous process), also was measured. We then determined the correlation between LIV and paraspinal muscle degeneration. There were no significant differences in BMI and lumbar lordosis between age groups. CSA of the paraspinal muscles tended to decrease with age, and fat infiltration rate increased with age. There was a negative correlation between CSA and fat infiltration rate at all levels (r = -0.474 to -0.634). LIV decreased significantly with age and strongly correlated with CSA at all levels (r = 0.709-0.789). Our new index is a simple and effective parameter for evaluating paraspinal muscle degeneration associated with aging. 4.

Reliability of measurements of the extension-flexion ratio with surface EMG.

The surface electromyography (sEMG), by evaluating the paraspinal muscle activity, may be used for diagnosis and evaluation of rehabilitation effectiveness patients with low back pain. The purpose of the study was to determine the intra- and inter-session reliability of the measurement of the activity of the lumbar erector spinae (LES) activity (extension-flexion ratio). The study included 21 asymptomatic subjects, aged 14 to 27 years, mean 23.7 ± 2.9. The LES muscle activity was assessed with using of the sEMG during forward trunk flexion and extension by two examiners. Based on the quotient of the LES muscle activity obtained during four concentric and eccentric tasks the extension-flexion ratio was calculated. The measurements displayed excellent or fair-to-good reliability (intraclass correlation coefficient ranged from 0.90 to 0.68). The typical error and coefficient of variations, ranged from 0.34 to 0.58, and from 13.7 to 21.9, respectively. The measurement of the extension-flexion ratio performed with the use of sEMG shows high level of intra- and inter-session reliability, suggesting that this parameter is a reliable tool in evaluation of the lumbar paraspinal muscles activity. However, the level of typical error should be taken into account.

‘Growing mushroom on the back’ following minimally invasive spine fixation: The theory of iatrogenic compartment syndrome revisited

Abstract The authors report a case of lumbar para-spinal muscle herniation following percutaneous thoraco-lumbar pedicle screw fixation. This is suggested to be due to subclinical iatrogenic increase in the intra-compartmental pressure. The possibility of ‘Iatrogenic paraspinal compartment syndrome’ following minimally invasive spine techniques has been discussed previously by other authors. Nevertheless, no such case has been reported so far in the literature. The awareness of this potential complication might be helpful for spinal surgeons for early detection and management.

Postural responses to anterior and posterior perturbations applied to the upper trunk of standing human subjects.

This study concerned the effects of brisk perturbations applied to the shoulders of standing subjects to displace them either forwards or backwards, our aim being to characterise the responses to these disturbances. Subjects stood on a force platform, and acceleration was measured at the level of C7, the sacrum and both tibial tuberosities. Surface EMG was measured from soleus (SOL), tibialis anterior (TA), the hamstrings (HS), quadriceps (QUAD), rectus abdominis (RA) and lumbar paraspinal (PS) muscles. Trials were recorded for each of four conditions: subjects’ eyes open (reference) or closed and on a firm (reference) or compliant surface. Observations were also made of voluntary postural reactions to a tap over the deltoid. Anterior perturbations (mean C7 acceleration 251.7 mg) evoked activity within the dorsal muscles (SOL, HS, PS) with a similar latency to voluntary responses to shoulder tapping. Responses to posterior perturbations (mean C7 acceleration −240.4 mg) were more complex beginning, on average, at shorter latency than voluntary activity (median TA 78.0 ms). There was activation of TA, QUAD and SOL associated with initial forward acceleration of the lower legs. The EMG responses consisted of an initial phasic discharge followed by a more prolonged one. These responses differ from the pattern of automatic postural responses that follow displacements at the level of the ankles, and it is unlikely that proprioceptive afferents excited by ankle movement had a role in the initial responses. Vision and surface properties had only minor effects. Perturbations of the upper trunk evoke stereotyped compensatory postural responses for each direction of perturbation. For posterior perturbations, EMG onset occurs earlier than for voluntary responses.Electronic supplementary materialThe online version of this article (doi:10.1007/s00221-015-4442-2) contains supplementary material, which is available to authorized users.

CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels

BackgroundRecognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. As such, it is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI).MethodsA total of 30 adult cadavers were studied by sectional anatomic dissection, and 60 patients were examined using CT (16 slices, 3-mm thickness, 3-mm intersection gap, n = 30) and MRI (3.0T, T2-WI, 5-mm thickness, 1-mm intersection gap, n = 30). The distances between the midline and the superficial points of the intermuscular spaces at different intervertebral disc levels were measured.ResultsBased on study of our cadavers, the mean distances from the midline to the intermuscular space between multifidus and longissimus, from intervertebral disc levels L1–L2 to L5–S1, were 0.9, 1.1, 1.7, 3.0, and 3.5 cm, respectively. Compared with the upper levels (L1–L3), the superficial location at the lower level (L4–S1) is more laterally to the midline (P<0.05). The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4–S1. The intermuscular spaces in patients also varied at different levels of the lumbar spine showing a low discontinuous density in CT and a high signal in MRI. There were no significant differences between the observations in cadavers and those made using CT and MRI.ConclusionThe intermuscular spaces within the paraspinal muscles vary at different intervertebral disc levels. Preoperative CT and MRI can facilitate selection of the muscle-splitting approach to the lumbar spine. This paper demonstrates the efficacy of medical imaging techniques in surgical planning.

Postoperative posterior lumbar muscle changes and their relationship to segmental motion preservation or restriction: a randomized prospective study.

To date, it remains unclear whether the preservation of segmental motion by total disc replacement (TDR) or motion restriction by stand-alone anterior lumbar interbody fusion (ALIF) have an influence on postoperative degeneration of the posterior paraspinal muscles or the associated clinical results. Therefore, the purpose of the present prospective randomized study was to evaluate the clinical parameters and 3D quantitative radiological changes in the paraspinal muscles of the lumbar spine in surgically treated segments and superior adjacent segments after ALIF and TDR. A total of 50 patients with chronic low-back pain caused by single-level intervertebral disc degeneration (Pfirrmann Grade ≥ III) and/or osteochondrosis (Modic Type ≤ 2) without symptomatic facet joint degeneration (Fujiwara Grade ≤ 2, infiltration test) of the segments L4-5 or L5-S1 were randomly assigned to 2 treatment groups. Twenty-five patients were treated with a stand-alone ALIF and the remaining 25 patients underwent TDR. For ALIF and TDR, a retroperitoneal approach was used. At 1 week and at 12 months after surgery, CT was used to analyze paraspinal lumbar muscle tissue volume and relative fat content. Residual muscle tissue volume at 12 months and change in the relative fat content were compared between the groups. In addition, clinical parameters (visual analog scale [VAS] for low-back pain and Oswestry Disability Index [ODI] Questionnaire Version 2 for function) were compared. Compared with 1 week after surgery, the radiological analysis at 12 months revealed a small decrease in the posterior muscle volume (the mean decrease was < 2.5%), along with a small increase in the relative fat content (the mean increase was < 1.9%), in both groups at the index and superior adjacent segments. At the adjacent segment, the ALIF group presented significantly less muscle tissue volume atrophy and a smaller increase in fat content compared with the TDR group. At final follow-up, the clinical parameters related to pain and function were significantly improved in both groups compared with 1 week postsurgery, but there were no differences between the groups. Motion restriction via stand-alone ALIF and motion preservation via TDR both present small changes in the posterior lumbar paraspinal muscles with regard to volume atrophy or fatty degeneration at the index and superior adjacent segments. Therefore, although the clinical outcome was not affected by the observed muscular changes, the authors concluded that the expected negative influence of motion restriction on the posterior muscles compared with motion preservation does not occur on a clinically relevant level.

Negative Impact of Modic I Degenerative Disc Disease on Lumbar Paraspinal Muscles

PM&RVolume 7, Issue 9S p. S90-S90 Best Pain and Spine Medicine Research Podium Presentation Negative Impact of Modic I Degenerative Disc Disease on Lumbar Paraspinal Muscles Emel E. Ozcan Eksi MD, Emel E. Ozcan Eksi MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJapjot Bal, Japjot Bal Student University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJulio Carballido-Gamio PhD, Julio Carballido-Gamio PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorRoland Krug PhD, Roland Krug PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorSigurd Berven MD, Sigurd Berven MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorBobby Tay MD, Bobby Tay MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJeffrey Lotz PhD, Jeffrey Lotz PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorSibel Demir-Deviren MD, Sibel Demir-Deviren MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this author Emel E. Ozcan Eksi MD, Emel E. Ozcan Eksi MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJapjot Bal, Japjot Bal Student University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJulio Carballido-Gamio PhD, Julio Carballido-Gamio PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorRoland Krug PhD, Roland Krug PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorSigurd Berven MD, Sigurd Berven MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorBobby Tay MD, Bobby Tay MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorJeffrey Lotz PhD, Jeffrey Lotz PhD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this authorSibel Demir-Deviren MD, Sibel Demir-Deviren MD University of California San Francisco, San Francisco, CA, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.038Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S90-S90 RelatedInformation

Neuromechanical Responses After Biofeedback Training in Participants With Chronic Low Back Pain: An Experimental Cohort Study

ObjectiveThe objective of this study was to evaluate changes in neuromechanical responses and clinical outcomes in chronic low back pain participants after 4 sessions of biofeedback training. MethodsTwenty-one participants took part in an electromyography biofeedback 4-session training program aimed at reducing lumbar paraspinal muscle activity during full trunk flexion. The sessions consisted of ~46 trunk flexion-extension divided into 5 blocks. The effects of training blocks and sessions on lumbar flexion-relaxation ratio and lumbopelvic ranges of motion were assessed. Changes in disability (Oswestry Disability Index), pain intensity (numerical rating scale), and fear of movement (Tampa Scale for Kinesiophobia) were also evaluated. ResultsAnalyses of variance revealed a significant block effect for which an increase in the flexion-relaxation ratio and the lumbar range of motion between block 1 and the other blocks for sessions 1 and 2 (P < .0001) was observed. However, no significant session or interaction effect was observed. Among clinical outcomes, only fear of movement significantly decreased between the baseline (mean [SD], 33.05 [7.18]) and the fourth session (29.80 [9.88]) (P = .02). There was no significant correlation between clinical outcomes and neuromechanical variables. ConclusionBiofeedback training led to decreases in lumbar paraspinal muscle activity in full trunk flexion and increases in lumbopelvic range of motion in participants with chronic nonspecific low back pain. Although the neuromechanical changes were mostly observed at the early stage of the program, the presence of a decrease in the fear of movement suggests that the participants' initially limited ROMs may have been modulated by fear avoidance behaviors.

Lumbar paraspinal muscle transverse area and symmetry in dogs with and without degenerative lumbosacral stenosis.

To investigate whether dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle transverse area and symmetry compared with control dogs. Retrospective cross-sectional study comparing muscles in transverse T2-weighted magnetic resonance images for nine dogs with and nine dogs without degenerative -lumbosacral stenosis. Mean transverse area was measured for the lumbar multifidus and sacrocaudalis dorsalis lateralis muscles bilaterally and the L7 vertebral body at the level of the caudal endplate. Transverse areas of both muscle groups relative to L7 and asymmetry indices were compared between study populations using independent t tests. Mean muscle-to-L7 transverse area ratios were significantly smaller in the degenerative lumbosacral stenosis group compared with those in the control group in both lumbar multifidus (0·84 ±0·26 versus 1·09 ±0·25; P=0·027) and sacrocaudalis dorsalis lateralis (0·5 ±0·15 versus 0·68 ±0·12; P=0·005) muscles. Mean asymmetry indices were higher for both muscles in the group with degenerative lumbosacral stenosis than in the control group, but highly variable and the difference was not statistically significant. These findings suggest that dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle mass that may be a cause or consequence of the -syndrome. Understanding altered paraspinal muscle characteristics may improve understanding of the -pathophysiology and management options for degenerative lumbosacral stenosis.

Alterations in Lumbar Paraspinal Muscle Structure after Long Duration Spaceflight and Recovery

Spaceflight results in moderate to severe lumbar pain in some astronauts. Moreover, the incidence of herniated nucleus pulposus is about four times greater in US astronauts, as compared to matched controls. In addition, it is unclear if exercise countermeasures during their International Space Station (ISS) missions prevent lumbar paraspinal muscle deconditioning. PURPOSE: To quantify functional paraspinal muscle cross sectional area before, immediately after, and 30-days after 6-month ISS missions. METHODS: To date complete data sets of three astronauts were available for this MRI paraspinal muscle cross sectional area study. Functional cross-sectional area (FCSA) was measured in four lumbar paraspinal muscles (multifidus, erector spinae, quadratus lumborum, and psoas) at lumbar vertebral level 3/4. The FCSA was measured by setting a threshold to isolate altered lean muscle. RESULTS: Long duration spaceflight produced a significant mean 15.1% decrease (p=0.023) in total lumbar paraspinal muscle (multifidus, erector spinae, quadratus lumborum, and psoas) FCSA of the three crewmemebers, as compared to before flight (Table 1). In addition, approximately 63% of this FCSA loss recovered by 30-days after their ISS mission and was not significantly different from before flight (p=0.152). CONCLUSION: These early data indicate that the exercises conducted by these crewmembers did not mitigate decrements in lumbar paraspinal muscle FCSA during spaceflight. However, post-flight recovery activities resulted in a 63% recovery 30-days after their mission. Therefore, these data suggest that spaceflight induced back pain and elevated disc herniation risk may be partly related to reduced dynamic trunk stability linked to atrophied lumbar paraspinal muscles. Supported by NASA grant # NNX13AM89G (to ARH) and NSBRI through NASA NCC 9-58 (to BRM).

MRI Features of Psoas Major Muscles in Patients with Paraspinal Muscle Atrophy

Introduction Maintaining both lumbar lordosis and paraspinal muscle function is important for prevention of sagittal imbalance. We previously reported that the cross-sectional area of the paraspinal muscles tends to decrease with age. To quantify the depth of the groove between the paraspinal muscles, we have developed our own parameter, the T-back value, which indicates the length of the bulge of muscle on the attachment of the spinous process. The T-back value is strongly correlated with the CSA of the paraspinal muscles. The occurrence of T-back value of 0 or less shows a marked increase in individuals aged 60 years or older. The CSA of the paraspinal and psoas muscles shows a similar decreasing trend with age, but fat infiltration of the paraspinal muscles is far more prominent than that of the psoas muscles in the elderly. The aims of this study are to investigate the CSA and fat infiltration of the psoas muscles in patients with paraspinal muscle atrophy, and to compare the findings with those in patients having a T-back value above 0. Methods Among 704 patients who underwent MRI of the lumbar spine at our hospital during 2010, 141 patients had a T-back value of 0 or less. Of these 141 patients, there were 120 patients, 40 men and 80 women, aged 60 years or older. We defined these as T-back − group. The control group included 120 age- and sex-matched individuals with a T-back value above0. We defined them as T-back + group. We compared their data from the two groups. The body mass index (BMI) of participants was calculated. Lumbar lordosis was measured on sagittal T2-weighted MR images. Axial T2-weighted MR images and a digital image analysis technique were used to measure the cross-sectional area and the percentage of fat infiltration of the paraspinal and psoas muscles at the intervertebral disc levels from L1/2 to L4/5 bilaterally. Then the mean values of both sides were used as CSA and the percentage of fat respectively Results The T-back − group had a significantly lower BMI than the T-back + group. Lumbar lordosis was significantly smaller in the T-back − group than in the T-back + group. In addition, the CSA of the paraspinal muscles was significantly smaller in the T-back − group than the T-back + group. The %Fat of the paraspinal muscles was significantly higher in the T-back − group than the T-back + group. When the CSA of the psoas muscles was compared across all spinal levels, there was no significant difference between the two groups. The %Fat of the psoas muscles also showed no significant difference between the two groups. Conclusion The patients in this study were divided into two groups according to the T-back value. The T-back − group had a smaller BMI, less lumbar lordosis, and the advanced atrophy of the paraspinal muscles than the T-back + group. However, MRI features of the psoas muscles were similar in the two groups. This study demonstrates that the psoas muscles are less susceptible to atrophy than the paraspinal muscles.

A Case of Change in Work Out as the Presenting Symptoms of Multiple Myeloma

HISTORY: A 56 year-old active black male presented with 5 months of worsening chronic pain: right hip pain changed location and low back pain flared. His pain had not responded to maintenance exercises (weightlifting, running, stationary cycling), dry needle, massage, stretch, or anti-inflammatories. Past medical history included lumbar disc bulge, lumbar spondylolysis, right superior labral tear, sports lifting-related Osgood-Schlatter’s, cervical laminectomy, chronic right rectus femoris strain. PHYSICAL EXAMINATION: Compared to examination seven months prior, physical examination was significant for decrease in lumbar spine flexion, extension, lateral lean, and rotation and normal symmetric strength testing over the bilateral lower extremities. Forward bending as if to tie shoes, lifting objects, and walking several blocks reproduced his pain. DIFFERENTIAL DIAGNOSIS: 1.Lumbar vertebral body fracture 2.Herniated disc 3.Lumbar or sacroiliac joint sprain or dysfunction 4.Lumbar paraspinal muscles strain 5.Malignancy - primary or secondary 6.Infection - osteomyelitis TESTS AND RESULTS: Serum protein electrophoresis: elevated IgM level Bone marrow biopsy #1: smoldering multiple myeloma Bone scan #1: negative. Lumbosacral x-ray: stable spondylolysis MRI lumbosacral spine: stable lumbar disc bulge, new L2 infiltrative lesion. Non-contrast CT: L2 lytic process with pathologic fracture Bone scan #2: photopenic foci at L2 and right scapula Skeletal survey #1: negative Bone marrow biopsy #2: plasma cell neoplasm Skeletal survey #2: lesions at L2, left pelvis, bilateral proximal femurs as well as bilateral osteoarthrosis of glenohumeral joints and left sacroiliitis FINAL WORKING DIAGNOSIS: Stage 2 multiple myeloma TREATMENT AND OUTCOMES: 1.Radiation and chemotherapy 2.Clamshell TLSO for lumbar lordosis 3.Simplifed exercise program: upright stationary cycle, overhead reach, back extension stretches. Focus on core strength, hip flexibility. 4.Advance to stairs, pool running, captain’s chair, bird dog, and abdominal press 5.Avoid overhead lifting and compressive spine exercises 6.Treatment complicated by pulmonary embolism. 7.Tolerance of bending and lifting improved participation in household activities. 8.Goal: to return to weight lifting exercises and outdoor biking.

First Report of Recurrent Intramuscular Lipoma after Decompression Surgery of the Lumbar Spine

Intramuscular or infiltrating lipomas are rare. We present a 58-year-old man with an intramuscular lipoma developing after decompression surgery for lumbar spinal canal stenosis. One year after macroscopically complete lipoma resection, an even bigger recurrent tumor had to be removed. The lumbar paraspinal musculature is a very uncommon site for an intramuscular lipoma. A relation between surgery and the growth and recurrence of an intramuscular lipoma has not been described previously in the literature.

Lumbar Paraspinal Muscle Atrophy during Long Duration Spaceflight

Spaceflight results in significant lumbar pain and muscle atrophy in astronauts. The rate of disc herniation is about four times greater in US astronauts than in matched controls. Muscles are vital spine stabilizers, and trunk muscle atrophy is associated with chronic back pain. Yet, it is unclear whether current countermeasures during 6‐month International Space Station (ISS) missions prevent lumbar paraspinal muscle atrophy.PURPOSETo quantify paraspinal muscle functional cross sectional area (FCSA) before, immediately after, and 30‐days after 6‐month ISS missions.METHODSTo date, complete paraspinal MRI data for three astronauts were available. FCSA was measured in four lumbar paraspinal muscles (multifidus, erector spinae, quadratus lumborum, and psoas) at lumbar vertebral level 3/4. FCSA was measured by setting a threshold to isolate lean muscle.RESULTSLong duration spaceflight produced a significant 15.1% decrease (p=0.023) in total lumbar paraspinal muscle FCSA, as compared to before flight (Table 1). Subsequently 63.3% of FCSA loss was recovered by 30‐days post flight and was not significantly different from before flight (p=0.152).imageCONCLUSIONDespite low sample size, paraspinal muscle atrophy is not prevented by current countermeasures on 6‐month ISS missions. However, recovery activities resulted in a 63% recovery 30‐days post flight. This suggests spaceflight induced back pain and disc herniation risk may be partly related to reduced dynamic trunk stability linked to atrophied lumbar paraspinal muscles.Project supported by NASA grant # NNX13AM89G (to ARH) and NSBRI through NASA NCC 9‐58 (to BRM).

Sex differences in predicting chronicity of low-back pain after acute trauma using lumbar muscle area.

The aim of this study was to investigate sex differences in predicting chronicity of low-back pain after acute trauma using cross-sectional areas of paraspinal (multifidus and erector spinae) and psoas muscles. Between January 2006 and December 2010, a total of 54 patients were interviewed at least 6 mos after the trauma event. The subjects were classified into chronic low-back pain group and improved low-back pain group according to the presence of low-back pain for more than 6 mos. The cross-sectional area of the multifidus, erector spinae, and psoas muscles was measured at the level of the lower margin of the L3 and L5 vertebrae using magnetic resonance imaging. The cross-sectional area of the multifidus and erector spinae muscles at L5 in the chronic low-back pain group was significantly smaller than that of the improved low-back pain group (P < 0.05) in the men. There were no significant differences in the other parameters between the groups in the men. There were no significant differences in any parameters in the women. In the men, the cross-sectional area of the multifidus and erector spinae muscles at the lower lumbar level can be considered to be prognostic factors for the chronic low-back pain after acute trauma. The authors thus suggest that strengthening of lumbar paraspinal muscles could be helpful for preventing chronicity of low-back pain.

チェンソーを用いる伐倒作業姿勢の違いが体幹筋群の筋活動量に与える影響

Many forestry workers who use chain-saws suffer from low back pain. Previous studies have reported that low back pain is related to the working postures while felling a tree with a using chain-saws. However, no previous study has investigated trunk muscle activities during work. The purpose of this study was to clarify the relationship between working postures while holding a chain-saw, and trunk muscles activities as measured by surface electromyography (EMG). Subjects were 10 males who were not forestry workers. Four task postures while holding a chain-saw were tested: standing, 30(o) trunk flexion, 90(o) trunk flexion and half-kneeling. EMG recordings were obtained bilaterally of the lumbar paraspinal (LP) muscles and rectus abdominis (RA) muscles. Raw EMG data were processed by integrating the EMG and normalizing them to %MVC. The paired t-test was used to detect statistical differences in the activities between the right and left LP muscles and RA muscles. One-factor repeated measures ANOVA was used to compare the bilateral LP and RA muscle activities among the 4 different postures. The significance level was set to less than 5%. In the half-kneeling posture, the right LP muscle activity was 14.7% higher than the left LP muscle activity (p<0.05); however, there were no significant differences in muscle activities among the other postures. The right LP muscle activity of 30(o) trunk flexion posture was 25.6% higher than that of the standing posture, and 14.2% higher than that of half-kneeling posture (p<0.05). The bilateral LP muscle activities of the 90(o) trunk flexion posture were the highest of the 4 postures, 16.7% higher than the half-kneeling posture (p<0.05) right LP muscle activity. There was a tendency of increase in the left LP muscle activity when trunk flexion angle increased, but no significant differences among the 4 postures were found. The bilateral RA muscle activities were low and did not significantly differ among the 4 postures. This study showed that when the trunk is flexed, the LP muscle activities change asymmetrically, with the right LP muscle activity increasing significantly compared to the standing posture and the half-kneeing posture, but there was no significant difference in the left LP muscle activity. These results suggest that working postures that involve trunk flexion while felling a tree with a holding chain-saw may lead to increased loading of the LP muscles.

Does lumbar paraspinal muscle fatty degeneration correlate with aerobic index and Oswestry disability index?

Background:We sought to analyze whether the amount of paraspinal fatty degeneration correlates with a patient's physical fitness, and to determine if these findings on lumbar magnetic resonance imaging (MRI) scans can help predict functional outcomes.Methods:A retrospective review was performed on 172 patients. Inclusion criteria involved being seen by a spine surgeon for low back pain, having aerobic index (AI), body mass index (BMI), Oswestry disability index (ODI), and body fat percentage measured recently, and having had a recent lumbar MRI scan. The percentage of fatty muscle degeneration was graded by three reviewers using T2-weighted axial images at L3 and L5 using a newly proposed system that was validated independently. The system is graded as follows: Grade 1: 0-24%, Grade 2: 25-49%, Grade 3: 50-74%, and Grade 4: 75-100%. An independent t-test was used for comparisons.Results:The average AI was 34.87, and the cohort was divided into two groups: above-average AI (89 patients) and below-average AI (83 patients). For all paraspinal fat measurements and body fat percentage, the difference between the above- and below-average AI groups was statistically significant (P < 0.05), with the least amount of paraspinal fatty degeneration and body fat in the greater AI group. Weight alone and BMI were not found to be significantly different between those with above-average AI when compared to those with below-average AI (P = 0.491 and P = 0.122, respectively). There was a trend for lower ODI scores in the above-average AI group (41.9 vs 46.1), but this did not reach statistical significance between the two groups (P = 0.075). For all patients it was shown that there was significantly less paraspinal fat at the L3 level as compared to L5 (P < 0.001).Conclusions:We were able to show that patients with a higher AI have lower body fat percentages and lower amounts of fatty degeneration in their lumbar paraspinal musculature. The amount of paraspinal fatty degeneration, therefore, correlates with physical fitness. Patients with higher AI also showed a trend toward having a lower ODI score.

Bilateral pallidal deep brain stimulation in idiopathic dystonic camptocormia.

Camptocormia is seen with Parkinson's disease (PD), segmental or generalized dystonia, extensor myopathies, anterior horn cell disorders, and muscle disorders. In severe selected cases of PD with camptocormia and dystonic camptocormia, deep brain stimulation (DBS) has been tried with variable success. In this paper, the first case report of its kind from India, we report a case of dystonic camptocormia who underwent DBS and review the available literature. A 42-year-old male, presented with dystonia of 5-year duration, that initially started with cervical dystonia and later progressed to severe disturbance of posture causing involuntary truncal flexion induced by standing or sitting. The camptocormia was completely relieved when sitting on a chair or lying down on the bed. Routine blood testing was normal. The workup for secondary dystonia including slit lamp examination for Kayser-Fleischer ring and serum copper studies did not reveal any abnormality. Magnetic resonance imaging of the brain was unremarkable. The electromyogram of the lumbar and thoracic paraspinal muscles was also normal. The patient was initially treated with multiple drugs and Botulinum A toxin which were ineffective. He underwent bilateral globus pallidus interna (GPi) DBS Over a period of 2 weeks; there was a mild reduction in the dystonia of the trunk and neck. The maximum improvement in dystonia, approximately 30% over baseline, was noted at 2 weeks postsurgery and over a further long-term follow-up, the improvement was 50% as determined by the sub-item (trunk) assessment of the Burke-Fahn-Marsden (BFM) dystonia score. Cervical dystonia improved by >90% in sub-item (neck) assessment of BFM scale. In this report, we have shown the efficacy of GPi DBS in the treatment of drug refractory dystonia associated camptocormia. Although only reported for PD associated camptocormia, evaluation for truncal extensor myopathy is mandatory in these cases also to achieve a good outcome.