Multifidus Research Articles

Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy.

A retrospective cohort study. The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age ( R =-0.358, P =0.002), preoperative JOA score ( R =0.286, P =0.021), preoperative PCS ( R =0.603, P <0.001), C2-C7 lordotic angle ( R =-0.284, P =0.017), stenosis severity ( R =-0.271, P =0.019), and Goutallier classification at the C7 level ( R =-0.268, P =0.021). In multiple linear regression analysis, sex (β=-0.334, P =0.002), age (β=-0.299, P =0.013), preoperative PCS (β=0.356, P =0.009), and Goutallier classification at the C7 level (β=-0.280, P =0.018) were significantly related to 2-year postoperative PCS. Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. Level III.

Miyoshi myopathy associated with spine rigidity and multiple contractures: a case report

BackgroundDysferlinopathy is a phenotypically heterogeneous group of hereditary diseases caused by mutations in the DYSF gene. Early contractures are considered rare, and rigid spine syndrome in dysferlinopathy has been previously reported only once.Case presentationWe describe a 23-year-old patient with Miyoshi myopathy with a rigid spine and multiple contractures, a rare phenotypic variant. The disease first manifested when the patient was 13 years old, with fatigue of the gastrocnemius muscles and the development of pronounced contractures of the Achilles tendons, flexors of the fingers, and extensors of the toes, followed by the involvement of large joints and the spine. Magnetic resonance imaging revealed signs of connective tissue and fatty replacement of the posterior muscles of the thighs and lower legs. Edema was noted in the anterior and medial muscle groups of the thighs, lower legs, and the multifidus muscle of the back. Whole genome sequencing revealed previously described mutations in the DYSF gene in exon 39 (c.4282 C > T) and intron 51 (c.5785-824 C > T). An immunohistochemical analysis and Western blot showed the complete absence of dysferlin protein expression in the muscle fibers.ConclusionsThis case expands the range of clinical and phenotypic correlations of dysferlinopathy and complements the diagnostic search for spine rigidity.

Repeatability of ultrasonographic measurement of cross‐sectional area of the multifidus muscle in the horse

SummaryBackgroundRecent studies have described techniques to acquire ultrasound measurements of the cross‐sectional area of the multifidus muscle to investigate back pain in horses and monitor the response to rehabilitation. These techniques have been extrapolated from human research but have not been clinically validated in the horse.ObjectiveThe objective of the study was to investigate whether measuring the cross‐sectional area of the multifidus muscle in horses using ultrasound is a repeatable technique.Study designCross‐sectional.MethodsUltrasound images of the articular process view and interspinous view of the multifidus muscle were acquired at T15, T18, L2 and L5 on the left and right sides. Three images were acquired at each location and each image was measured three times to give an average cross‐sectional area. Study 1 investigated the repeatability of acquiring images in a single session, and then on two separate days. Study 2 compared measurements of images acquired with a console (Philips EpiQ) and a portable (MyLab™Alpha) ultrasound machine. Study 3 investigated the repeatability of measuring the cross‐sectional area using external software, OsiriX. Intraclass correlation coefficients (ICC) were calculated for each study.ResultsRepeatability varied from good to excellent for images taken in a single session. The repeatability for measuring the images using external software was good to excellent. There was poor‐to‐moderate repeatability for images taken on two different days and poor‐to‐good repeatability when using the two different machines.Main limitationsPopulation size, study population limited to a single breed, only one operator.ConclusionsThe measurement of the multifidus muscle in horses has poor repeatability and may have limited application.

Evidence of MRI image features and inflammatory biomarkers association with low back pain in patients with lumbar disc herniation

BACKGROUND CONTEXTWhile MRI image features and inflammatory biomarkers are frequently used for guiding treatment decisions in patients with lumbar disc herniation (LDH) and low back pain (LBP), our understanding of the connections between these features and LBP remains incomplete. There is a growing interest in the potential significance of MRI image features and inflammatory biomarkers, both for quantification and as emerging therapeutic tools for LBP. PURPOSETo investigate the evidence supporting MRI image features and inflammatory biomarkers as predictors of LBP and to determine their relationship with pain intensity. STUDY DESIGNProspective cohort study. PATIENT SAMPLEAll consecutive patients with LDH who underwent discectomy surgery at our institution from February 2020 to June 2023 at the author's institution were included. OUTCOME MEASURESMRI image features in discogenic, osseous, facetogenic, and paraspinal muscles, as well as inflammatory biomarkers in serum (including CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), PCT (procalcitonin), TNF (tumor necrosis factor), interleukin-1 beta (IL-1β), and IL-6), and paraspinal muscles (including TNF, IL-1β, IL-6, IL-10, and transforming growth factor beta 1 (TGF-β1)). METHODSA series of continuous patients diagnosed with LDH were categorized into acute LBP (<12 weeks), chronic LBP (≥12 weeks), and nonLBP groups. MRI image features and inflammatory biomarkers relation to pain intensity was assessed using the independent t-test, Chi-squared tests, Spearman rank correlation coefficient, and logistic regression test. RESULTSCompared to the nonLBP group, the chronic LBP group exhibited a higher incidence of intervertebral disc (IVD) degeneration (≥ grade 3) and high-fat infiltration in paraspinal muscles, alongside a significant reduction in the cross-sectional area (CSA) and fatty degeneration of the multifidus muscle. Furthermore, there was a greater expression of IL-6 in serum and TNF in paraspinal muscles in the chronic LBP group and a greater expression of CRP and IL-6 in serum and TNF in paraspinal muscles in the acute LBP group. CSA and fatty degeneration of multifidus muscle were moderately negatively correlated with chronic LBP scores. The expression of TNF and IL-6 in serum and the expression of TNF in the multifidus muscle were moderately correlated with preoperative LBP. IVD degeneration and high-fat infiltration were identified as risk factors for chronic LBP. CONCLUSIONThe results provide evidence that IVD degeneration, high-fat infiltration, and the reduction of CSA in paraspinal muscles were associated with the development of chronic LBP in patients with LDH, and these associations are linked to inflammatory regulation. This deepens our understanding of the etiology and pathophysiology of LBP, potentially leading to improved patient stratification and more targeted interventions.

Bilateral Activity of Spine Extensors and Rotators during Asymmetric Lumbar Stabilization Exercises Executed in Prone, Quadruped, and Standing-Prone Positions

(1) Background: Most daily activities and sport gestures involve asymmetric movement patterns of the upper and lower extremities, transferring asymmetric mechanical loadings to the spine. Therefore, asymmetric lumbar stabilization exercises are frequently prescribed in athletic programs and preventive/rehabilitation interventions. This study analyzed the bilateral activity of the thoracic erector spinae (ES), lumbar multifidus (MF), external oblique (EO), and internal oblique (IO) during asymmetric lumbar stabilization exercises executed in prone, quadruped, and standing-prone positions, rising an upper and/or lower limb in all possible combinations. A limited subset of these data has been previously published in earlier studies. (2) Methods: Surface EMG signals were bilaterally recorded from the selected muscles using wireless EMG sensors. (3) Results: ES, MF, and oblique muscles’ activity was significantly higher in prone, standing-prone, and quadruped positions, respectively, and was maximized by specific limb rise combinations (up to 69%, 64%, 34%, and 24% maximum-voluntary-isometric-contraction for ES, MF, EO, and IO). The bilateral difference in muscle activation was significantly higher in the quadruped position and revealed different strategies used to stabilize the body in response to the different exercise conditions. (4) Conclusions: The study results can provide deeper insights into the stabilizing function of the lumbar and oblique muscles and aid in designing optimal progressions for lumbar stabilization exercises.

Fatty infiltration and morphology of cervical muscles in patients with temporomandibular disorders: A case-control study.

Changes in the fatty infiltration and/or muscle volume of neck muscles can alter cervical spine alignment and cranial load distribution, which may cause pain in the orofacial region. The aim of the study was to examine the muscle volume and fatty infiltration of neck muscles in patients with temporomandibular disorders (TMD). This case-control study included 18 patients with TMD and 18 ageand sex-matched controls. The muscle volume and fatty infiltration of the neck muscles of the participants were measured using magnetic resonance imaging (MRI) and ITK-SNAP software. The 3D models of the sternocleidomastoid (SCM), splenius capitis (SPLC), semispinalis cervicis (SC)-semispinalis capitis (SCP), and multifidus (M) muscles within the C3-C7 range were created using ITK-SNAP, a semi-automatic segmentation software. The models were used to determine the volumes and fatty infiltration levels. The Neck Disability Index (NDI) was used to assess neck pain-related disability. The severity of TMD was determined using the Fonseca Anamnestic Index (FAI), while jaw-related disability was measured with the Jaw Functional Limitation Scale-20 (JFLS-20). Pain levels were recorded at rest and during chewing using the numeric rating scale (NRS). There were no statistically significant differences in total muscle volume, fatty infiltration volume and fatty infiltration percentage of the SCM, SPLC, SCP, SC, and M muscles between the 2 groups (p > 0.05). The patient group had higher NDI scores compared to the controls (p < 0.001). The NDI scores correlated positively with the JFLS-20 (r = 0.831, p < 0.001), FAI (r = 0.815, p < 0.001) and NRS scores at rest (r = 0.753, p < 0.001) and during chewing (r = 0.686, p < 0.001). The present study did not identify any significant differences in the neck muscle volume or fatty infiltration between the TMD patients and controls. However, the severity of neck disability was found to correlate with jaw function, pain and TMD levels.

Impact of poor prognostic risk for chronic low back pain on functionality and lumbopelvic stability: a cross-sectional observational study

Internal load to deal with physical exercise demand depends on the psychophysical capacity. As psychosocial aspects affect patients suffering chronic low back pain (CLBP), we hypothesized that the higher the risk of poor prognosis, the lower the psychophysical capacity and, consequently, the worse the performance in functional tasks that involve walking. To verify the impact of the risk of poor prognosis of patients with CLBP on functional performance and physiological intensity (PI), representative of the task internal load, in a walking test and on lumbopelvic region static and dynamic stability. Cross-sectional observational study. Volunteers of both sexes, physically inactive, were divided into four groups according to the Start Back Screening Tool: control (CG) CLBP free, and low (LrG), medium (MrG), high (HrG) poor prognostic risk. The outcomes were static stability, with emphasis on the action of the transverse and multifidus muscles, and dynamic stability of the lumbopelvic region, both measured by a biofeedback pressure unit, as well as functional capacity, and physiological intensity in the 6-minute walk test. The GEE and complementary metrics (minimum detectable change and effect size) were used for statistical analysis. The sample consisted of 70 volunteers. The outcomes were proportionally affected by the risk of poor prognosis (the higher the risk, the worst performance) and the complementary metrics corroborated inferential statistics. The risk of poor prognosis negatively and proportionally impacts both the static and dynamic lumbopelvic stabilization capacity and the performance and the PI in walking of individuals with CLBP.

Factors influencing slippage after microsurgical single level lumbar spinal decompression surgery - Are the psoas and multifidus muscles involved?

Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients. Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2mm was assessed on the last follow-up X-ray. We included 95 patients with average age and follow-up periods of 69 ± 8.2years and 7.51 ± 2.58years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression. Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.

Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study.

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.

Quantitative Evaluation of the Lumbar Multifidus Muscle by Shear Wave Dispersion in Healthy Adults: A Preliminary Study.

To investigate the application value of shear wave dispersion (SWD) in healthy adults with the lumbar multifidus muscle (LMM), to determine the range of normal reference values, and to analyze the influences of factors on the parameter. Ninety-five healthy volunteers participated in the study, from whom 2-dimensional, shear wave elastography (SWE), and SWD images of the bilateral LMM were acquired in three positions (prone, standing, and anterior flexion). Subcutaneous fat thickness (SFH), SWE velocity, and SWD slope were measured accordingly for analyses. The mean SWD slope of the bilateral LMM in the prone position was as follows: left: 14.8 ± 3.1 (m/second)/kHz (female) and 13.0 ± 2.5 (m/second)/kHz (male); right: 14.8 ± 3.7 (m/second)/kHz (female) and 14.2 ± 3.4 (m/second)/kHz (male). In the prone position, there was a weak negative correlation between the bilateral LMM SWD slope of activity level 2 and level 1 (β = -1.5 (2 versus 1, left), -1.9 (2 versus 1, right), all P < .05), and between the left SWD slope of activity level 3 and level 1 (β = -2.3 [3 versus 1, left], P < .05). The correlation between SWE velocity and SWD slope value changed with the position: there was a weak positive correlation in the prone position (r = 0.3 [left], 0.37 [right], both P < .05), and a moderate positive correlation in the standing and anterior flexed positions (r = 0.49-0.74, both P < .001). SFH was moderately negatively correlated with bilateral SWD slope values in the anterior flexion (left: r = -0.4, P = .01; right: r = -0.7, P < .01). SWD imaging can be used as an adjunct tool to aid in the assessment of viscosity in LMM. Further, activity level, and position are influencing factors that should be considered in clinical practice.

Fatty Infiltration of Multifidus Muscles: An Easily Overlooked Risk Factor for the Severity of Osteoporotic Vertebral Fractures.

Osteoporotic vertebral fractures (OVFs) are a critical public health concern requiring urgent attention, and severe OVFs impose substantial health and economic burdens on patients and society. Analysis of the risk factors for severe OVF is imperative to actively prevent the occurrence of this degenerative disorder. This study aimed to investigate the risk factors associated with the severity of OVF, with a specific focus on changes in the paraspinal muscles. A total of 281 patients with a first-time single-level acute OVF between January 2016 and January 2023 were enrolled in the study. Clinical and radiological data were collected and analyzed. The cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles, including the multifidus muscles (MFMs), erector spinae muscles (ESMs), and psoas major muscles (PSMs), were measured by magnetic resonance imaging (MRI) of the L4/5 intervertebral discs. According to the classification system of osteoporotic fractures (OF classification) and recommended treatment plan, OVFs were divided into a low-grade OF group and a high-grade OF group. Univariate and multivariate logistic regression analyse s were performed to identify risk factors associated with the severity of OVF. Ninety-eight patients were included in the low-grade OF group, and 183 patients were included in the high-grade OF group. Univariate analysis revealed a significantly higher incidence of a high degree of FI of MFMs (OR = 1.71, p = 0.002) and ESMs (OR = 1.56, p = 0.021) in the high-grade OF group. Further multivariate logistic regression analysis demonstrated that a high degree of FI of the MFMs (OR = 1.71, p = 0.002) is an independent risk factor for the severity of OVF. A high degree of FI of the MFMs was identified as an independent risk factor for the severity of OVF. Decreasing the degree of FI in the MFMs might lower the incidence of the severity of OVF, potentially reducing the necessity for surgical intervention in OVF patients.

Asymmetric expression of PIEZO2 in paraspinal muscles of adolescent idiopathic scoliosis.

Muscle imbalance has long been recognized as one of the possible pathogeneses for adolescent idiopathic scoliosis (AIS). PIEZO2, the susceptibility gene of AIS, has been identified to play an important role in neuromuscular activities. This study aims to compare the mRNA expression of PIEZO2 between concave and convex paraspinal muscles of AIS patients and to identify the relationship between the ratio of PIEZO2 expression and curve magnitude. Twenty female AIS patients (right thoracic curve) who underwent spinal correction surgery were divided into moderate (n= 12) and severe (⩾ 70 degrees) curve groups (n= 8). The morphology of the paraspinal muscles was assessed with spinal MRI. Multifidus specimens were collected during surgical operations from the concave and convex sides of the apical region, and mRNA expression of the PIEZO2 gene was compared between sides. The localization of PIEZO2 protein expression was confirmed with the markers PAX7 and PAX3, and the percentage of PIEZO2+ cells was also investigated. In the moderate curve group, fatty infiltration in the deep paraspinal muscle was significantly higher on the concave side than on the convex side. There were no differences in deep muscle area, superficial muscle area, or fatty infiltration of superficial paraspinal muscle. The mRNA expression of PIEZO2 was significantly increased on the concave side, and the asymmetric expression predominantly occurred in moderate curves rather than severe ones. PIEZO2 was expressed on satellite cells instead of fibers of the muscle spindle. The percent of PIEZO2+PAX7+ cells in myofibers was significantly higher on the concave side in the moderate curve group, but not in the severe curve group. Asymmetric morphological changes occur in the deep paraspinal muscles of AIS. The PIEZO2 is asymmetrically expressed in the multifidus muscle and is preferentially expressed in satellite cells.

Effects of vibration-based biofeedback on multifidus muscle activity and pelvic tilt angle in subjects with hip flexion limitation.

Sedentary work may lead to low back pain. In particular, a slumped sitting position may exacerbate low back pain because of tissue damage caused by excessive lumbar flexion and posterior pelvic tilting. Subjects with low back pain may have excessive changes in the lumbopelvic posture and back muscle activity in the sitting position. The purpose of this study was to compare the effects of vibration-based biofeedback using a motion sensor belt and no biofeedback on multifidus (MF) muscle activity and pelvic tilt angle during typing. Thirty subjects with low back pain accompanied by hip flexion limitation (15 each in the biofeedback and non-biofeedback groups) were enrolled. Electromyography was used to investigate MF muscle activity before and after typing for 30 min. Pelvic tilt was measured after typing in a sitting position for 30 min. Independent t-tests were used to compare MF muscle activity, and pelvic and second sacrum tilt angles, between the biofeedback and non-biofeedback groups. After typing for 30 min, changes in MF muscle activity (11.45% and -7.19% for the biofeedback and nonbiofeedback groups, respectively) and pelvic and second sacrum tilt angles (3.15∘ and 4.12∘ for the biofeedback group and -11.05∘ and -18.16∘ for the non-biofeedback group, respectively) were significantly smaller in the biofeedback than non-biofeedback group (p< 0.05). Vibration-based biofeedback minimizes the reduction in MF muscle activity and changes in pelvic and second sacrum tilt angles during typing in individuals with low back pain accompanied by hip flexion limitation.

Exploring Relationships Between Size and Function of Trunk Muscles, Injuries and Concussion in a Professional Rugby League Team

Abstract Purpose Examine for injury risk factors and establish clinical cut-off values related to size and function of trunk muscles. Methods A prospective study of 28 professional Rugby League players was conducted. Cross-sectional areas (CSAs) of the multifidus (MF), quadratus lumborum (QL) and ability to contract the abdominal and MF muscles were measured from pre-season ultrasound images. Playing season injuries resulting in games missed were recorded by club personnel. Logistic regression models were used to determine the adjusted odds ratios for trunk muscle measures as risk factors for playing season injuries. Results The adjusted odds ratio (OR) values indicated that if a player had a small MF muscle (&lt; 9.98 cm2 at L5; P = 0.032) or a small QL (&lt; 10.8 cm2; P = 0.045), their odds of more games missed due to season injuries was increased (OR MF = 9.4; 95% CI = 1.21–72.9; OR QL = 7.3; 95% CI = 1.1–51.6). For players with increased contraction of the MF (contraction &gt; 7.2%; P = 0.028) and abdominal muscles (&gt; 49.9%; P = 0.08), the odds of sustaining a concussion were increased (OR MF 14.5; 95% CI 1.3–159; OR transversus abdominis 6.2; 95% CI = 0.8–48.6). Conclusion As size and ability to contract trunk muscles are modifiable factors, further intervention studies targeting motor control of these muscles may be warranted.

Relationship between paravertebral muscle degeneration and spinal-pelvic sagittal parameters in patients with lumbar disc herniation

Lumbar disc herniation (LDH) is a clinically common degenerative disease of the spine, and spinal–pelvic sagittal balance and paravertebral muscle degeneration have been a research focus in recent years. To explore the relationship between the degeneration of paravertebral muscle and the changes in the spinal–pelvic sagittal parameters in LDH patients, 105 LDH patients (experimental group) and 63 healthy volunteers (control group) hospitalized in Ordos Central Hospital from January 2020 and January 2023 were included as study subjects. All the patients underwent lumbar magnetic resonance imaging and spinal X-ray using uniform criteria. The correlation between the paravertebral muscle and sagittal–pelvic sagittal parameters of the patients with LDH was obtained from two imaging examinations, and the data were organized and grouped to explore the correlation between these parameters. No significant difference in general data existed between the groups (P > 0.05). In the L4/5 LDH patients group, the ratio of fat infiltration (FIR) in the healthy side [multifidus (MF) and erector spinae (ES)] was negatively correlated with the lumbar lordosis (LL) (r = −0.461, r = −0.486, P < 0.05). The relative cross-sectional area (RCSA) of the bilateral MF was positively correlated with the pelvic tilt (r = 0.549, r = 0.515, P < 0.05). The bilateral ES RCSA was negatively correlated with the sagittal vertical axis (r = −0.579, r = −0.621, P < 0.05). A positive correlation existed between the RCSA and thoracic kyphosis in the healthy side ES (r = 0.614, P < 0.05). In the L5/S1 LDH patients group, a negative correlation existed between the FIR and LL in the healthy side ES (r = −0.579, P < 0.05). Thus, the paravertebral muscle parameters were correlated with the spinal–pelvic sagittal parameters in the patients with LDH.

Relationship between the postoperative variations of paraspinal muscles and adjacent-segment degeneration in patients with degenerative lumbar spinal stenosis after posterior instrumented lumbar fusion.

This study aimed to quantify pre- and postoperative paraspinal muscular variation following posterior lumbar interbody fusion (PLIF) in patients with degenerative lumbar spinal stenosis (DLSS) and measure the association of this variation with adjacent-segment degeneration (ASD). Data from 149 patients who underwent L4-S1 PLIF for DLSS were collected. Patients were divided into radiologically confirmed ASD and control groups according to follow-up radiological findings. MRI was performed before surgery and at the last follow-up. Muscular parameters including the relative cross-sectional area (rCSA), relative functional cross-sectional area (rFCSA), relative total cross-sectional area (rTCSA), and fatty infiltration (FI) of the multifidus (MF), erector spinae (ES), and psoas major (PM) muscles were measured on preoperative and follow-up L2-S1 MR images. Logistic regression was used to investigate risk factors for ASD. The rate of radiological ASD was 42.3% at the final follow-up (mean 25.71 ± 8.35 months). At surgical levels, the rFCSA and rTCSA of the MF and ES muscles decreased. The FI of the MF from L2-3 to L5-S1 and ES muscles at L5-S1 significantly increased after surgery, while the rFCSA and rTCSA of the PM muscle increased and its FI decreased. At adjacent levels, the rFCSA and rTCSA of the MF muscle and rTCSA of the ES muscle decreased and the FI of the MF muscle increased postoperatively (p < 0.05), but the rFCSA and rTCSA of the PM muscle increased and its FI decreased (p < 0.05). The FIs of the MF, ES, and PM muscles at adjacent levels significantly differed between the ASD and control groups. Logistic regression analysis indicated that higher BMI (p = 0.002) and FI of the PM muscle at adjacent levels (p = 0.025) were significant risk factors for ASD. The functional area decreased in the MF and ES muscles and increased in the PM muscle after L4-S1 PLIF. A compensatory postoperative decrease in FI of the PM muscle at the adjacent level was a protective factor for ASD in DLSS patients after PLIF.

The effect of whole-body vibration therapy on mechanical nociceptive thresholds and postural stability in horses with thoracolumbar pain

ObjectivesTo determine the effects of WBV on thoracolumbar pain, multifidus muscle CSA, and postural stability in horses with thoracolumbar pain AnimalsTen horses with thoracolumbar pain ProceduresHorses received WBV for 30 minutes once daily, 5 days per week, for 30 days. Mechanical nociceptive thresholds (MNTs) at T13, T18, L3, L6, S2 were assessed on days 0, 1, 14, and 30. Ultrasound of the multifidus muscle cross-section area (CSA) and postural sway (2 conditions: flat square stance and standing on proprioceptive balance pads) were assessed on days 0 and 30. ResultsMNTs were significantly lower than baseline on day 1 (P<0.001) and day 14 (P=0.004). MNTs were significantly higher than baseline on day 30 (P<0.001). Mediolateral accelerations were significantly lower on day 30 compared to day 0 (P< 0.001). Multifidus muscle cross-sectional area was significantly increased on day 30 compared to day 0 (P = 0.0005). Clinical relevanceWBV may exacerbate pain in horses with thoracolumbar pain when used short-term (<14 days). Long-term use (4 weeks) is needed to improve thoracolumbar pain. Four weeks of once daily WBV is sufficient to improve postural stability and increase multifidus muscle CSA.

O exercício de agachamento recruta músculos do tronco tanto quanto exercícios localizados

Abstract Introduction In the context of resistance training, which encompasses both strengthening and rehabilitation, the incorporation of global range exercises demands intense activation of the trunk muscle groups, which play a primary role in body stabilization. The squat, notorious for its complexity and effectiveness in activating stabilizers during execution, raises a central question: whether this exercise recruits the muscles more significantly compared to localized exercises, such as push-ups and trunk exten-sions. Objective To identify the degree of activation of the trunk muscles during squats and compare it with localized exercises for the trunk muscles: lumbar and abdominal. Methods Using surface electromyography, the activation of the iliocostalis, multifidus, internal oblique, external oblique and rectus abdominis muscles was evaluated. The sample included 16 physically active volunteers of both sexes. A repeated measures t-test (α &lt; 0.05) was used as an analysis method. Results The iliocostalis, multifidus and internal oblique muscles showed similar levels of activation both in the squat and in their respective isolated exercises, while the rectus abdominis and external oblique muscles showed greater activity during trunk flexion. Conclusion It is possible to infer that squats are an effective exercise for training the iliocostalis, multifidus and internal oblique muscles, while localized exercises are more suitable for strengthening the external oblique and rectus abdominis muscles. Such conclusion can contribute to optimizing the planning of exercise sessions by replacing isolated trunk exercises with squats.

Investigation of the Relationship Between Multifidus Muscle and Lumbar Disc Herniation Through Magnetic Resonance Imaging

Investigation of the Relationship Between Multifidus Muscle and Lumbar Disc Herniation Through Magnetic Resonance Imaging

Effect of Sacral Erector Spinae Plane Block on Postoperative Analgesia in Perianal Surgeries: A Randomised Controlled Trial

Introduction: Sacral nerves emerge through sacral foramina and traverse below the multifidus muscle. Hence, blocking this myofascial plane can provide postoperative analgesia in the perianal region by blocking the sacral nerves supplying it. Aim: To study the effect of Sacral Erector Spinae Plane Block (SESPB) on postoperative pain and postoperative analgesic requirement in perianal surgeries. Materials and Methods: A randomised controlled trial was done with 60 patients who were randomly allocated into two groups (30 in each group). Group 1 patients received no intervention, whereas Group 2 received bilateral SESPB. The Visual Analogue Scale (VAS), opioid requirement, first analgesic demand, and additional analgesic requirement were compared between the two groups. The qualitative data was analysed by Student’s t-test, whereas the quantitative data was analysed using the Chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: Around 18 (60%) of the participants in group 1 were males, whereas group 2 consisted of 15 (50%) males. The mean age in group 1 was 40.7±11.5 years, whereas it was 43.6±12.7 years in group 2. The means of BMI were similar in both groups. The mean VAS score of group 1 was 3.19±0.23, whereas it was 2.37±0.25 in group 2. The first analgesic requirement was significantly delayed, and total tramadol requirement was lower in group 2 compared to group 1. Four patients from group 1 (control group) required inj. diclofenac sodium additionally. Conclusion: Bilateral SESPB provided good postoperative analgesia in patients who underwent perianal surgery. The total analgesic requirement was also found to be lower with this block. Hence, it can be considered a modality for perianal surgeries.