Paravertebral Muscles In Patients Research Articles

Abdominal Aortic Calcification is Associated with Degeneration of The Paraspinal Muscles - A Retrospective cross-sectional Study.

Retrospective cohort study. To analyze the relationship of abdominal aortic calcification (AAC) and a reduction in the cross-sectional area (CSA) and the fatty infiltration (FI) of the paravertebral muscles in patients undergoing lumbar fusion surgery. Both AAC and paraspinal muscle degeneration have been shown to be associated with poorer outcomes after surgical treatment of degenerative diseases of the lumbar spine. However, there is a lack of data on the association between AAC and paraspinal muscle changes in patients undergoing spine surgery. We retrospectively analyzed patients undergoing lumbar fusion for degenerative spinal pathologies. Muscular and spinal degeneration were measured on magnetic resonance imaging (MRI). AAC was classified on lateral lumbar radiographs. The association of AAC and paraspinal muscle composition was assessed by a multivariate regression analysis adjusted for age, sex, body mass index (BMI), comorbidities, and lumbar degeneration. A total of 301 patients was included. Patients with AAC showed significantly higher degrees of intervertebral disc and facet joint degeneration as well as higher total endplate scores at the L3/4 level. The univariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae (b=0.530, P<0.001) and multifidus (b=0.730, P<0.001). The multivariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae (b=0.270, P=0.006) and a significant negative correlation between the degree of AAC and the CSA of the psoas muscle (b=-0.260, P=0.003). This study demonstrates a significant and independent association between AAC and degeneration of the erector spinae and the psoas muscles in patients undergoing lumbar fusion. As both AAC and degeneration of paraspinal muscles impact postoperative outcomes negatively, preoperative assessment of AAC may aid in identifying patients at higher risk after lumbar surgery.

Quantitative analysis of paravertebral muscle asymmetry and its correlation with spinal deformity in patients with degenerative lumbar scoliosis: a retrospective case-control study.

The degeneration and functional decline of paravertebral muscles (PVMs) are reported to be closely linked to the incidence of degenerative lumbar scoliosis (DLS), a spinal deformity of the mature skeleton. However, the functional role and degeneration of PVMs and their relationship to the development of spinal deformities remain controversial. Therefore, the present study analyzed the morphological changes in the PVMs of patients with DLS, and explored the relationship between PVM degeneration and spinal osseous parameters. In this retrospective case-control study, we evaluated the PVM parameters of patients with DLS (n=120) and compared them with patients free of DLS (control group, n=120). The cross-sectional area (CSA) and computed tomography (CT) values of the PVM at the lumbar vertebra 1-5 levels were measured. Further, the lumbar scoliosis Cobb, lumbar lordotic, and apical vertebral rotation angles were measured on CT and radiographs in the DLS group, and the relationship between PVM changes and these factors was analyzed. In the control group, the PVM CSA and CT values differed insignificantly between the bilateral sides at all levels (P>0.05). In the DLS group, the CSAs of the multifidus (MF) and erector spinae (ES) were larger on the convex side than the concave side (P>0.05), whereas that of the psoas major (PM) was smaller on the convex side than the concave side (P<0.05). The CT value of the PVM was lower on the convex side at all levels (P<0.05). The CSA and CT values on both sides of the patients were lower in the DLS group than the control group at all levels (P<0.05). Further, the degree of PVM asymmetry at the apical vertebral level was positively correlated with the lumbar scoliosis (P<0.01) and apical vertebral rotation angles (P<0.05), but negatively correlated with the lumbar lordotic angle (P<0.05). Asymmetric degeneration of the PVM was observed bilaterally in DLS patients, and the degeneration was more pronounced on the concave side than the convex side. This asymmetrical degeneration was closely associated with the severity of lumbar scoliosis, vertebral rotation, and loss of lumbar lordosis, and a stronger correlation was observed with the MF and ES than with the PM.

The Effect of Intraabdominal Visceral and Subcutaneous Adipose Volume and Muscle Volume on Lumbar Vertebrae Degeneration.

This study aimed to investigate the effect of the volume of subcutaneous, visceral, and total adipose tissue, and paravertebral muscles in patients with lumbar vertebrae degeneration (LVD) through computerized tomography (CT) images. One forty-six patients with a complaint of lower back pain (LBP) between January 2019 and December 2021 were included in the study. CT scans of all patients were analyzed retrospectively for abdominal visceral, subcutaneous, and total fat volume, and also paraspinal muscle volume measurements and analysis of lumbar vertebrae degeneration (LVD) using designated software. In CT images, each intervertebral disc space was evaluated in terms of the presence of osteophytes, loss of disc height, sclerosis in the end plates, and spinal stenosis to investigate the presence of degeneration. Each level was scored according to the presence of findings, with 1 point for each finding. The total score at all levels (L1-S1) was calculated for each patient. An association was observed between the loss of intervertebral disc height and the amount of visceral, subcutaneous, and total fat volume at all lumbar levels (p˂0.05). The amount of all fat volume measurements also showed association with osteophyte formation (p˂0.05). An association was found between sclerosis and the amount of all fat volume at all lumbar levels (p˂0.05). It was observed that spinal stenosis at the lumbar levels was not associated with the amount of fat (total, visceral, subcutaneous) at any level (p˃0.05). No association was found between the amount of adipose and muscle volumes and vertebral pathologies at any level (p˃0.05). The abdominal visceral, subcutaneous, and total fat volumes are associated with lumbar vertebral degeneration and loss of disc height. Paraspinal muscle volume does not show an association with vertebral degenerative pathologies.

Upregulated estrogen receptors impairs myogenesis and elevates adipogenesis related factor levels in the paravertebral muscles of patients with idiopathic scoliosis

The prevalence of idiopathic scoliosis (IS) is 2–3% worldwide and is more common in girls. Estrogen receptors (ERs) is supposed to be related to sex differences and development of IS. Meanwhile, paravertebral muscle (PVM) abnormalities play important roles in the pathogenesis of IS. But the changes of ERs between the PVMs from IS patients and controls, and the mechanism by which ERs may affect IS patients remain unclear. Thus, the expression levels of ERs, myogenesis regulator (MYOG) and adipogenesis related factors (CEBPA, PPARγ, FABP4), as well as morphological changes in the PVMs and primary skeletal muscle mesenchymal progenitor cells (hSM-MPCs) of IS patients and controls were investigated. Increased expression levels of ERs and CEBPA, PPARγ, FABP4, together with severe myofiber necrosis and fat infiltration, were found in the PVMs of IS patients. Meanwhile, upregulated ERs, FABP4 and CEBPA, downregulated MYOG and impaired myogenesis were also revealed in the hSM-MPCs of IS patients compared with those of controls. Upregulation of ERs inhibited myogenesis but increased expression of CEBPA and FABP4 in C2C12 myoblasts. Nevertheless, treatment of ER antagonist increased expression of MYOG, enhanced myogenesis and decreased expression of CEBPA and FABP4 in skeletal muscle cells of IS patients. Therefore, our study suggested that PVMs specific upregulation of ERs could impair myogenesis and increase the expression of adipogenesis related factors, further leading to PVMs abnormalities in IS patients.

Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years’ follow-up

ObjectiveThe purpose of this study was to investigate the relationship between surgical segment mobility and fatty infiltration of the adjacent segment paravertebral muscles in patients with single-segment lumbar degenerative disease (LDD) who underwent decompression with fusion or dynamic stabilization.MethodsRetrospective analysis of patients who underwent lumbar decompression combined with titanium rod fixation intertransverse fusion (PITF group), Isobar TTL dynamic stabilization (TTL group) or Isobar EVO dynamic stabilization (EVO group) for single-segment lumbar degenerative disease, from March 2012 to July 2018. The preoperative and final follow-up clinical indexes C-LDSI and the measured imaging indexes (range of motion of the surgical segment and the upper adjacent segment, and Goutallier grade of the upper adjacent segment) were counted, and the differences between the preoperative and final follow-up indexes were compared.ResultsAccording to the inclusion and exclusion criteria, 68 patients were included in this study, 21 in the PITF group, 24 in the TTL group, and 23 in the EVO group. At the final follow-up, the C-LSDI score had significantly higher in the PITF group than the TTL and EVO groups, and the C-LSDI score was a very strongly negatively correlated with ROM of surgical segment (r=-0.7968, p < 0.001). There was a strong negative correlation between surgical segment and upper adjacent segment mobility (r = -0.6959, p < 0.001). And there was a very strong negative correlation between ROM of surgical segment and upper adjacent segment paravertebral muscle Goutallier classification (r = -0.8092, p < 0.001), whereas the ROM of the upper adjacent segment was strong positive correlated with the Goutallier classification (r = 0.6703, P < 0.001).ConclusionCompared with decompression combined with rigid fusion, decompression combined with dynamic fixation for single-segment lumbar degenerative disease can significantly reduce postoperative low back stiffness. And a certain range of increased mobility of the dynamic stabilization device can effectively reduce the compensatory mobility of the upper adjacent segment and slow down the fatty infiltration of the paravertebral muscle in the adjacent segment.

Asymmetric Biomechanical Properties of the Paravertebral Muscle in Elderly Patients With Unilateral Chronic Low Back Pain: A Preliminary Study.

Background: Clinical incidences of chronic low back pain among the elderly are increasing. However, studies have not fully elucidated on changes in biomechanical properties of paravertebral muscles in patients with unilateral chronic low back pain. We evaluated the changes in biomechanical properties of painful and non-painful paravertebral muscles in elderly patients with unilateral chronic low back pain. Methods: Biomechanical properties of paravertebral muscles, including muscle tone and stiffness, in elderly patients with unilateral chronic low back pain were measured using MyotonPRO. Lumbar Lordosis and Sacral Slope were measured by magnetic resonance imaging. Cross-sectional areas of paravertebral muscles were evaluated using ImageJ software version 1.53. Chronic low back pain severity was assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. The correlations between VAS scores, ODI scores, Lumbar Lordosis, Sacral Slope, cross-sectional areas (painful side), disease duration, and biomechanical properties of paravertebral muscles in the painful side were analyzed. Results: A total of 60 elderly patients with unilateral chronic low back pain were enrolled in this study. The muscle tone and stiffness of paravertebral muscles on the painful side were significantly higher than those on the non-painful side (p < .05). Cross-sectional areas of paravertebral muscles on the painful side at the L3 level were smaller than those of the non-painful side (p < .05). The VAS scores and ODI scores were significantly positively correlated with muscle tone and stiffness of paravertebral muscles on the painful side (p < .05 and p < .01, respectively). There were no significant correlations between disease duration, cross-sectional areas (painful side), Lumbar Lordosis, or Sacral Slope and muscle tone and stiffness of paravertebral muscles on the painful side (p > .05). Conclusion: In elderly patients with unilateral chronic low back pain, muscle tone and stiffness of paravertebral muscles on the painful side are higher than for those on the non-painful side. The asymmetry of biomechanical properties of paravertebral muscles is associated with severity of chronic low back pain.

Mechanical Properties of Lumbar and Cervical Paravertebral Muscles in Patients with Axial Spondyloarthritis: A Case-Control Study.

Background: Axial spondyloarthritis (axSpA) affects spinal muscles, due to inflammation and structural damage. The mechanical properties of the muscles, such as tone or stiffness, could be altered in axSpA. The aim of this work is to analyze the mechanical properties of cervical and lumbar spine muscles in axSpA patients and their relationship with metrology measures, function, disease activity, structural damage and quality of life. Methods: axSpA patients and age/gender/BMI matched healthy controls were recruited. The muscle mechanical properties (MMPs), such as tone or frequency, stiffness, decrement (linear elastic properties), relaxation and creep (viscoelastic properties), of cervical (semispinalis capitis) and lumbar (erector spinae) muscles were bilaterally measured at rest using myotonometry. Additionally, conventional metrology, BASMI (metrology index), BASDAI (disease activity index), mSASSS (radiological structural damage index) and SF-12 (health-related quality of life questionnaire) were used in the axSpA group. Between-groups comparison, intra-group correlations and multivariable regression analyses were performed to achieve the study aims. Results: Thirty-four axSpA patients (mean age: 46.21 ± 8.53 y) and 34 healthy volunteers (mean age: 43.97 ± 8.49 y) were recruited. Both in cervical and lumbar spine, linear elastic parameters were significantly higher in axSpA patients in comparison with controls, while viscoelastic parameters were significantly lower. Lumbar muscle frequency, stiffness, relaxation, creep and cervical muscle elasticity were fair to strongly correlated (|0.346| < r < |0.774|) with age, functional status, activity of disease, structural damage and quality of life in axSpA patients. Furthermore, moderate to good fitted multivariate models (0.328 < R2 < 0.697) were obtained combining age, conventional metrology, activity of the disease and function for the estimation of cervical and lumbar MMPs. Conclusion: Mechanical properties of spinal muscles of axSpA patients differ from controls. Lumbar and cervical muscles exhibit greater linear elastic properties and lower viscoelastic properties, which are related with age, clinical and psychophysiological features of axSpA.

CT evaluation for sarcopenia involving the psoas and paravertebral muscles in patients with total hip arthroplasty.

Computed tomography (CT) has been validated in diagnosing sarcopenia in various clinical conditions. To evaluate the core abdominal muscles in terms of sarcopenia in patients with total hip arthroplasty (THA) with and without complication. Retrospective analysis of patients with a pelvic CT revealed 145 consecutive patients with THA. Also, 118 consecutive cases with normal CT scans constituted the control group. The area and density measurements of bilateral psoas (PSA, psoas area; PSD, psoas density) and paravertebral (PVA, paravertebral area; PVD, paravertebral density) muscles were performed at the level of L3 or L4 vertebrae regardless of prosthesis side. All measurements were evaluated in normal cases and in patients with THA, as well as in patients with complicated prostheses. In the whole population and subgroup of patients with bilateral THA, bilateral PSA, PSD, and PVD but not the PVA were lower in patients with THA compared to controls (all p < 0.01). In patients with unilateral prostheses, ipsilateral PSA, PSD, and bilateral PVD but not the PVA were lower compared to controls (all p < 0.01). Furthermore, in patients with unilateral prostheses with complication, only ipsilateral PSD was lower compared to patients with unilateral prostheses without complication (all p < 0.05) and in patients with bilateral prostheses with complication, bilateral PSA, PSD, and PVD but not the PVA were lower compared to patients with bilateral prostheses without complication (all p < 0.05). Sarcopenia indicated by the area and density measurements of core abdominal muscles can be associated with the presence and complication of hip prostheses.

Abnormal expression of PAX3 in paravertebral muscles of patients with Adolescent Idiopathic Scoliosis.

Abnormal expression of PAX3 in paravertebral muscles of patients with Adolescent Idiopathic Scoliosis.

Asymmetric degeneration of paravertebral muscles in degenerative lumbar scoliosis and potential significance

Objective To measure the cross-sectional area (CSA) and fatty infiltration (FI) of lumbar paravertebral muscles in patients with degenerative lumbar scoliosis (DLS), and to analyze the mechanism and clinical significance of paravertebral muscles degeneration. Methods A retrospective study was performed on 118 patients with DLS who were enrolled in our hospital from September 2016 to September 2017. All patients had complete preoperative image data. Preoperative lumbar lordosis (LL), Cobb angle, and vertebral rotation were measured on spinal X-ray plain film. The CSA and FI of the paravertebral muscle on the upper and lower intervertebral level of the scoliosis apical vertebrae were measured by lumbar MRI, and the CSA, FI and their correlation with the Cobb angle were compared. Results This study enrolled 118 DLS patients, including 49 males and 69 females. The mean age of the patients was 65.4 ± 7.2 years, with an average BMI of 24.7 ± 3.4 and lumbar symptoms including LBP, sciatica, numbness and intermittent claudication, decreased myodynamia and other symptoms. The lasting time of symptoms were 21 months (3-60 months). The Cobb angle of the patients averaged 18.5°±6.7°. Of all patients, 60 patients had a scoliosis to the left, and 58 patients had a scoliosis to the right. The number of patients with lateral apical vertebrae located at L1-L4 were: 12 cases of L1, 41 cases of L2, 49 cases of L3, 16 cases of L4. The CSA of the concave side psoas muscle was significantly larger than that of the convex side(upper intervertebral level, concave side 3.74±2.17 cm2, convex side 3.56±1.91 cm2; lower intervertebral level, concave side 6.54±3.08 cm2, convex side 6.31±3.302 cm2. And the CSA of the concave side multifidus muscle and the extensor muscle group was significantly smaller than the convex side, multifidus muscle: upper intervertebral level, concave side 9.47±3.86 cm2, convex side 10.25±4.20 cm2; lower intervertebral level, concave side 9.30±3.61 cm2, convex side 10.21±3.81 cm2; extensor muscle group: upper intervertebral level, concave side 18.35±4.94 cm2, convex side 19.37±5.17 cm2; lower intervertebral level, concave side 18.98±4.73 cm2, convex side 19.81±5.16 cm2. The concave side FI of extensor muscle group is significantly larger than the convex side, upper intervertebral level, concave side 30.63±15.09, convex side 23.48±15.00; lower intervertebral level, concave side 37.87±19.38, convex side 30.43±16.89. There was a correlation between the degree of asymmetry of CSA and FI in the multifidus, dorsal extension muscles, paravertebral muscle and the scoliosis Cobb angle. Conclusion The paravertebral muscles of lumbar vertebrae are not a whole in the degenerative changes of DLS. There are different anatomical and physiological effects of lumbar flexion and extension muscle groups. The extensor muscles play an important role in antagonizing the progression of DLS. Improving paravertebral muscle function is an important element in the treatment of DLS. Key words: Scoliosis; Muscle, skeletal; Biomechanics

Ультрасонографія паравертебральних м’язів пацієнтів з дегенеративними захворюваннями поперекового відділу хребта та прогнозування результатів їх хірургічного лікування

Ультрасонографія паравертебральних м’язів пацієнтів з дегенеративними захворюваннями поперекового відділу хребта та прогнозування результатів їх хірургічного лікування

Morphological characteristics of paravertebral muscles in patients with scoliosis caused by primaryprogressive muscular dystrophies

To identify the morphological features of paraspinal muscles in patients with spinal pathology caused by progressive muscular dystrophy. The Traumatologic-and-Orthopedic Department of Axial Skeleton Pathology examined patients with scoliotic spinal deformity due to muscular dystrophy: 1) severe Duchenne X-linked muscular dystrophy (n=7); 2) Erb-Roth's autosomal recessive muscular dystrophy (n=2); 3) Landouzy-Dejerine facioscapulohumeral muscular dystrophy (n=2). For histopathological analysis of paraspinal muscles, an excisional biopsy was performed in the region of the apex of the strain angle (the convex side), and the specimens were fixed with 10% neutral formalin. Paraffin sections were stained with hematoxylin and eosin according to the Van Gieson and Masson trichrome staining methods. The preparations were examined using an AxioScope.A1 stereo microscope and an AxioCam digital camera ('Carl Zeiss MicroImaging GmbH', Germany). Sluggish moderate paraparesis and grade IV progressive neurogenic thoracolumbar scoliosis were predominant in the clinical picture of the disease. The muscle biopsy specimens were established to have muscle fiber profiles with lost polygonality, increased diameter variability, and centrally positioned or numerous internal nuclei (myophagy) and to be characterized by fiber contractures, fatty degeneration fields, interstitial fibrosis, and signs of axonopathy of intramuscular nerve conductors. The arterial blood vessels were spastic with fibrotic t. media and t. adventicia; the venous bed vessels were dilated, thin-walled, full-blooded, which causes blood corpuscle transudation and numerous hemorrhages. The identified morphopathological characteristics of muscle tissue in patients with progressive muscular dystrophy are very similar. However, Duchenne muscular dystrophy is the most severe pathology, in which fatty degeneration and sclerotization of muscle tissue and perimysial vessels are most pronounced. To solve this problem, there is a need for the integration of geneticists, biochemists, molecular biologists, pharmacologists, and histologists.

Changes in the paravertebral muscles in patients with degenerative diseases of the lumbar spine

Studying of changes in paravertebral muscles is necessary for understanding the prognosis of the course, developing strategies for the prevention and treatment of patients with degenerative diseases of the spine. Objective: to determine changes in paravertebral muscles in patients with degenerative diseases of the lumbar spine. Methods: 129 patients who were operated on the reason of instability, intervertebral disc hernias, spondylolisthesis, spinal stenosis, and 11 healthy volunteers were examined on a spiral computer tomograph SOMATOM Emotion. The content of fat, muscle and connective tissues in the paravertebral muscles was determined with the help of an original computer program. A correlation analysis for the assessment was performed. Results: in patients with intervertebral discs hernias, spondylolisthesis and stenosis of the vertebral canal, the fat content in the paravertebral muscles was higher than in the control group (7.24 ± 1.56) and (16.03 ± 1.62); (18.40 ± 2.17) and (19.70 ± 2.36) % relatively. The differences were more pronounced in m. multifid us and m. erector spinae . A significant decrease in the amount of muscle tissue was observed in patients with s pondylolisthesis (M–W U = 95, Z = –2.51082, p = 0.01) and stenosis (M–W U = 39, p = 0.007). The most pronounced changes, as in the case of fat tissue, were found in m. erector spine and m. multifidus. The content of connective tissue in groups with herniated intervertebral discs, spondylolisthesis and spinal stenosis did not differ from the control parameters, and in patients with instability its quantity was significantly higher. Conclusions: degenerative changes in the muscles directly correlate with disorders of other structures of the spine and progress depending on the diagnosis in the order: «instability – herniated intervertebral disc – spondylolisthesis – stenosis of the spinal canal».

Structural features of multifidus muscle in patients with degenerative diseases of the lumbar spine

Aim: to investigate the structural and functional changes in paravertebral muscles of patients with degenerative diseases of the spine based on histological and electron microscopic analyzes.Material and methods: histological and electron microscopic analysis of multifidus muscles of 49 patients (27 men and 22 women) was performed. Patients were on treatment between September 2015 and March 2018. The material was obtained during surgery for degenerative diseases of the spine: instability (9 patients), (11), (9), disc herniation (20).Results: dystrophic disorders of muscle fibers were detected. There were thickness unevenness, discoid decay, loss of transverse striation and polygonality, replacement of muscle fibers with fat tissue, proliferation of fibrous tissue, edema. Prevalence of adipose tissue was found in 20 % of patients with a disc 22.22 % with instability, 36.36 % with spondylolisthesis, 44.44 % with stenosis. The proliferation of connective tissue only in perimysium was defined in patients with a diagnosis lumbar disc herniation, in others – both in perimysium and in endomysium. At the ultramicroscopic level, in the postoperative material of the patients with and stenosis, in addition to intermyofibrillar edema and the violation of the architectonics of sarcomeres, as well as the structure and location of the mitochondria, focal necrosis of myofibrils were detected. Areas with a normal distribution of mitochondria were noted only in a group of patients with a disc herniation. In patients with a diagnosis of spinal stenosis violations of the ultrastructural organization of venules were found. This has a negative effect on nutrition and, accordingly, the functioning of a partitioned muscle.Conclusion: the greatest manifestations of dystrophic disorders of muscle fibers at the tissue and ultrastructural levels were revealed in patients with diagnoses of spondylolisthesis and spinal stenosis

Comparison of the cross-sectional area of longus colli muscle between patients with cervical radicular pain and healthy controls

Previous studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain, and proposed rehabilitative approaches based on these findings. However, changes of cervical paravertebral muscles in patients with cervical radicular pain are still unknown. The aim of this study was to compare the cross-sectional area (CSA) of longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. Twenty patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. The CSA of LCM at the level of C5–C6 was measured by ultrasound with the subject in a supine position. Also, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) were reported by patients. Independent sample t -test was used for investigation of differences in cross-sectional area and other variables between both groups. Twenty patients with cervical radicular pain with mean (SD) age of 42.4(7) years and 20 healthy matched controls with mean (SD) age of 40.7 (7) years participated in the study. Patients with cervical radicular pain showed smaller CSA of LCM bilaterally compared with controls [mean (SD) difference: 0.37(0.15)] ( P -value < 0.001). Within patients group, there were no significant differences between CSA of LCM in the involved and non-involved sides. This is the first study which showed that patients with cervical radicular pain had smaller bilateral CSA of LCM in comparison with healthy controls via ultrasound assessment. It is also not clear whether atrophy of longus colli muscle in patients with cervical radicular pain is a consequence or a cause of it. Reduction in the stability of neck due to atrophy of LCM could make the cervical spine region susceptible to more injuries which might be prevented by functional and strengthening exercises.

Вміст ліпідів у паравертебральних м’язах пацієнтів з дегенеративними захворюваннями хребта

Вміст ліпідів у паравертебральних м’язах пацієнтів з дегенеративними захворюваннями хребта

Volumetric and Fatty Infiltration Imbalance of Deep Paravertebral Muscles in Adolescent Idiopathic Scoliosis.

BackgroundSeveral studies have described the differences in electromyographic activity and histological changes of paravertebral muscles in patients with adolescent idiopathic scoliosis (AIS). However, there is little knowledge about the muscle volumetric and fatty infiltration imbalance of patients with AIS.Material/MethodsThirty-four patients with AIS were evaluated with standardized anteroposterior (AP) and lateral standing films for the location and direction of the apex of scoliosis, coronal Cobb angle, apex vertebra translation, and thoracic kyphosis; and with magnetic resonance imaging (MRI) scan of the spine at the level of T4–L1. The muscle volume and fatty infiltration rate of bilateral deep paravertebral muscles at the level of upper end, apex, and lower end vertebra were measured.ResultsAll patients had major thoracic curve with apex of curves on the right side. The muscle volume on the convex side was larger relative to the concave side at the three levels, while the fatty infiltration rate was significantly higher on the concave side. The difference index of the muscle volume was significantly larger at the apex vertebra level than at the upper end vertebra level (p=0.002) or lower end vertebra level (p<0.001). The difference index of muscle volume correlated with apex vertebra translation (r=−0.749, p=0.032), and the difference index of fatty involution correlated with apex vertebra translation (r=0.727, p=0.041) and Cobb angle (r=0.866, p=0.005).ConclusionsOur findings demonstrated significant imbalance of muscle volume and fatty infiltration in deep paravertebral muscles of AIS patients. Moreover, these changes affected different vertebra levels, with the most imbalance of muscle volume at the apex vertebra. We interpreted this as morphological changes corresponding with known altered muscle function of AIS.

Differentiated resistance training of the paravertebral muscles in patients with unstable spinal bone metastasis under concomitant radiotherapy: study protocol for a randomized pilot trial

BackgroundMetastatic bone disease is a common and severe complication in patients with advanced cancer. Radiotherapy (RT) has long been established as an effective local treatment for metastatic bone disorder. This study assesses the effects of RT combined with muscle-training exercises in patients with unstable bone metastases of the spinal column from solid tumors. The primary goal of this study is to evaluate the feasibility of muscle-training exercises concomitant to RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed.Methods/DesignThis study is a single-center, prospective, randomized, controlled, explorative intervention study with a parallel-group design to determine multidimensional effects of a course of exercises concomitant to RT on patients who have unstable metastases of the vertebral column, first under therapeutic instruction and subsequently performed by the patients themselves independently for strengthening the paravertebral muscles. On the days of radiation treatment the patients will be given four different types of exercises to ensure even isometric muscle training of all the spinal muscles. In the control group progressive muscle relaxation will be carried out parallel to RT. The patients will be randomized into two groups: differentiated muscle training or progressive muscle relaxation with 30 patients in each group.DiscussionDespite the clinical experience that RT is an effective treatment for bone metastases, there is insufficient evidence for a positive effect of the combination with muscle-training exercises in patients with unstable bone metastases. Our previous DISPO-1 trial showed that adding muscle-training exercises to RT is feasible, whereas this was not proven in patients with an unstable spinal column. Although associated with several methodological and practical challenges, this randomized controlled trial is needed.Trial registrationClinicalTrials.gov, identifier: NCT02847754. Registered on 27 July 2016.

Comparative Analyses of Effects of Posture Variations on Neuromuscular Efficiency of Para-vertebral Muscles in Patients with Low Back Pain

This study investigated the neuromuscular efficiency of patients with Low Back Pain (LBP) at different spinal postures using electromyographic indices [Spinal Muscle Electrical Activities (SMEA) and Root Mean Square (RMS)]. This was with the view to establishing if there would be significant differences between SMEA of patients with Low Back Pain (LBP) and that of apparently healthy participants at different spinal postures. Thirty (30) patients with non – specific low back pain and 32 apparently healthy participants were recruited using purposive sampling technique. The SMEA and RMS at different spinal postures (erect standing, 30°, 45°, 90° spinal flexions and 30° spinal extension) were measured with a portable electromyography machine (MyoTrac infiniti System T 9800). Spinalflexion was measured with universal goniometer while pain intensity was measured using Numeric Pain Rating Scale. Disposable pregelled, tripolar, self-adhesive Ag/Agcl electrodes were placed in pairs with distance of 2cm from each other and parallel to the Longissimusdorsi and multifidus muscle fibers. The Spinal Muscle Electrical Activities were recorded for each participant at each of the postures while maintaining maximum voluntary contraction for 10 seconds. Descriptive statistics, Student t-test and Analysis of Variance were used to analyze the data. The level of significance was set at ≤ 0.05. There were significant differences in SMEA and RMS at different spinal postures among patients with LBP (F = 29.20, p = 0.001; F = 40.55 respectively, p = 0.001). The SMEA of patients with LBP were significantly lower at all postures compared to that of the age matched apparently healthy participants excluding at 30° spinal extension (t = 2.04, p = 0.05; t = -0.20; p = 0.84). Also, there were significant differences between the RMS of patients with LBP and the age matched apparently healthy participants at 30°, 45° and 90°spinal flexion (t = 2-79, p = 0.01; t = 2.61, p = 0.01; t = 5.19; p = 0.001 respectively). It was concluded that different postures affected neuromuscular efficiency of patients with low back pain. Also, neuromuscular efficiency at the para-vertebral muscles of low back pain patients for most spinal postures were significantly lower than that of the apparently healthy participants.

Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis

Aim: The purpose of this study was to assess morphological changes in the paravertebral muscles in patients with ankylosing spondylitis.Materials and methods: Fifty-one patients diagnosed with ankylosing spondylitis and a 50 member control group were included in the study. The surface area of the multifidus and erector spinae muscles was measured at four levels between L1 and L5, and fatty degeneration in these muscles was scored. Lumbosacral and lumbar lordotic angles were determined for the patient and control groups.Results: Loss of muscle cross-sectional area compatible with atrophy was present at all four levels in the paraspinal muscles in patients with ankylosing spondylitis. A negative correlation was observed between paravertebral muscle area and duration of disease at three levels, but not at L1-2. Although muscle area decreased with the duration of disease at the L1-2 level, this was not statistically significant (r= −0.195, p = 0.171). Comparison of intramuscular fatty degeneration between the groups revealed increased intramuscular fat at all levels in patients with ankylosing spondylitis, with the exception of L3–4, and a positive correlation between fatty degeneration and duration of disease was determined at all levels.Conclusion: Chronic inflammation, cytokine-mediated fibrosis, immobilization, and postural changes in ankylosing spondylitis contribute to fatty degeneration and atrophy in the paravertebral muscles.