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Journal of Personalized Medicine Sep 2023(1) Background: Paraspinal muscle degeneration affects the quality of life in patients with degenerative lumbar scoliosis (DLS) and lumbar spinal stenosis (LSS). We...
The Difference in Paraspinal Muscle Parameters and the Correlation with Health-Related Quality of Life among Healthy Individuals, Patients with Degenerative Lumbar Scoliosis and Lumbar Spinal Stenosis.
(1) Background: Paraspinal muscle degeneration affects the quality of life in patients with degenerative lumbar scoliosis (DLS) and lumbar spinal stenosis (LSS). We aimed to describe the characteristics and differences in the paraspinal muscle parameters between patients with DLS and LSS and investigate their correlation with health-related quality of life (HRQOL). (2) Methods: There were forty-four participants in each group, namely the DLS, LSS, and healthy groups, who were matched at a ratio of 1:1 according to age, sex, and BMI. Differences in paraspinal muscle parameters among the three groups were compared using analysis of variance or the Mann-Whitney U test, and paraspinal muscle degeneration and HRQOL were analyzed using Spearman's correlation analysis. (3) Results: In the upper lumbar, the psoas (PS), quadratus lumborum (QL), and multifidus (MF) cross-sectional area (CSA) in the DLS group were smaller than those in the other groups. In the lower lumbar region, the CSA of the PS, QL, erector spinae (ES), and gross CSA (GCSA) of the MF in the DLS group were not significantly different from those in the LSS group. These values were lower than those observed in the healthy group. The lean muscle fat index (LMFI) of the MF and ES groups was higher than those of the other groups. Regarding HRQOL, we found that PS and MF CSA were strongly associated with HRQOL in healthy individuals; however, only MF was associated with HRQOL in the LSS group. (4): Conclusion: PS in the upper lumbar region and MF degeneration were more severe in patients with DLS than in those with LSS. ES degeneration was similar between the LSS and DLS groups. MF muscle atrophy in patients with LSS and asymmetric changes in the MF in DLS are associated with quality of life.
PubMed: 37888049
DOI: 10.3390/jpm13101438 -
Spine Dec 2023This is a case-control study of prospectively collected data.
STUDY DESIGN
This is a case-control study of prospectively collected data.
OBJECTIVE
To quantify paraspinal muscle size asymmetry in adolescent idiopathic scoliosis (AIS) and determine if this asymmetry is (i) greater than observed in adolescent controls with symmetrical spines; and (ii) positively associated with skeletal maturity using Risser grade, scoliosis severity using the Cobb angle, and chronological age in years.
SUMMARY OF BACKGROUND DATA
AIS is a three-dimensional deformity of the spine which occurs in 2.5% to 3.7% of the Australian population. There is some evidence of asymmetry in paraspinal muscle activation and morphology in AIS. Asymmetric paraspinal muscle forces may facilitate asymmetric vertebral growth during adolescence.
METHODS
An asymmetry index [Ln(concave/convex volume)] of deep and superficial paraspinal muscle volumes, at the level of the major curve apex (Thoracic 8-9 th vertebral level) and lower-end vertebrae ( LEV , Thoracic 10-12 th vertebral level), was determined from three-dimensional Magnetic Resonance Imaging of 25 adolescents with AIS (all right thoracic curves), and 22 healthy controls (convex=left); all female, 10 to 16 years.
RESULTS
Asymmetry index of deep paraspinal muscle volumes was greater in AIS (0.16±0.20) than healthy spine controls (-0.06±0.13) at the level of the apex ( P <0.01, linear mixed-effects analysis) but not LEV ( P >0.05). Asymmetry index was positively correlated with Risser grade ( r =0.50, P <0.05) and scoliosis Cobb angle ( r =0.45, P <0.05), but not age ( r =0.34, P >0.05). There was no difference in the asymmetry index of superficial paraspinal muscle volumes between AIS and controls ( P >0.05).
CONCLUSIONS
The asymmetry of deep apical paraspinal muscle volume in AIS at the scoliosis apex is greater than that observed at equivalent vertebral levels in controls and may play a role in the pathogenesis of AIS.
Topics: Humans; Adolescent; Female; Scoliosis; Case-Control Studies; Australia; Magnetic Resonance Imaging; Kyphosis; Muscles; Imaging, Three-Dimensional; Thoracic Vertebrae
PubMed: 37432908
DOI: 10.1097/BRS.0000000000004715 -
PM & R : the Journal of Injury,... Feb 2024Paraspinal electromyography has proven to be the most sensitive component of the electrodiagnostic examination for lumbar spinal disorders. However, no standardized,... (Review)
Review
Paraspinal electromyography has proven to be the most sensitive component of the electrodiagnostic examination for lumbar spinal disorders. However, no standardized, anatomically validated technique has been proposed for the cervical region. This study reviewed the published textbooks on cervical paraspinal anatomy to develop a standardized electromyography technique and scoring system. A library search found 32 anatomy texts published between 2000 and 2021. Of these 11 were unique and appropriate. Most texts described the basic muscle anatomy similarly, but only one cited original research. When the spinous process is defined as the origin, the multifidus and deeper rotatores appear innervated by the posterior primary rami of single cervical roots. However, texts differ in the number of pennae, between two and five, traveling to transverse process regions below. These are crowded into a small area between the spinous processes and transverse processes. Based on this understanding, a proposed cervical paraspinal mapping technique involves skin insertions from 1 to 2 cm lateral to the C5, C7, and T2 spinous processes. The needle samples transversely and deep toward midline, contacts bone, then is withdrawn and redirected to sample medial and caudally to midline to bone, creating two scores of 0-4 at three levels, theoretically resulting in scores of 0-24. This technique must be validated by clinical research to determine the range of normal, reproducibility, and the spectrum of findings in various disorders.
Topics: Humans; Paraspinal Muscles; Reproducibility of Results; Electromyography; Neck
PubMed: 37515513
DOI: 10.1002/pmrj.13046 -
Regional Anesthesia and Pain Medicine Nov 2023Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has...
BACKGROUND
Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks.
METHODS
We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement.
RESULTS
A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research.
CONCLUSIONS
We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.
PubMed: 38050174
DOI: 10.1136/rapm-2023-104884 -
Quantitative Imaging in Medicine and... Jul 2023This study aimed to confirm the role of paraspinal muscle degeneration and low vertebral bone mineral density (vBMD) of the lumbosacral region in the development of...
The role of lumbosacral paraspinal muscle degeneration and low vertebral bone mineral density on distal instrumentation-related problems following long-instrumented spinal fusion for degenerative lumbar scoliosis: a retrospective cohort study.
BACKGROUND
This study aimed to confirm the role of paraspinal muscle degeneration and low vertebral bone mineral density (vBMD) of the lumbosacral region in the development of distal instrumentation-related problems (DIPs) in degenerative lumbar scoliosis (DLS) patients undergoing long-instrumented spinal fusion.
METHODS
From 2013 to 2019, 125 DLS patients with 24-month follow-up after long-instrumented spinal fusion in Beijing Chao-Yang Hospital were retrospectively recruited and divided into DIP and non-DIP groups. Demographic characteristics, surgical data, and radiographic parameters were statistically compared between the groups. Degeneration of the paraspinal muscle was evaluated using the relative gross cross-sectional area (rGCSA), relative functional cross-sectional area (rFCSA), ratio of the rFCSA to rGCSA, gross muscle-fat index, and functional muscle-fat index of the multifidus (MF), erector spinae (ES), paraspinal extensor muscle (PSE), and psoas major determined by preoperative magnetic resonance imaging (MRI). The vBMD of the lumbosacral region and lower instrumented vertebra (LIV) was assessed using Hounsfield unit (HU) values determined by computed tomography (CT) scans. The DeLong test was performed to select MRI and CT scan variables. Multivariable logistic regression analysis was applied to determine the independent predictive factors of DIPs.
RESULTS
The incidence of DIPs was 16.0% (20/105). There were no significant differences in demographic characteristics or surgical data between the groups. The rFCSAs of the MF (65.74±21.51 92.37±21.68; P<0.001), ES (82.67±21.44 111.48±24.21; P<0.001) and PSE (144.31±36.12 208.48±41.57; P<0.001) and the HU values of the lumbosacral region (103.80±22.64 . 132.19±19.17; P<0.001) and LIV (111.70±23.23 128.69±20.70; P=0.005) were significantly lower in the DIP group. Significantly less preoperative pelvic tilt and greater postoperative lumbosacral lordosis and sagittal vertical axis (SVA) values were observed in the DIP group. The rFCSA of the PSE, the HU value of the lumbosacral region, and the postoperative SVA value were detected as independent predictive factors of DIPs.
CONCLUSIONS
Lower muscularity of the PSE, a lower vBMD of the lumbosacral region, and postoperative sagittal malalignment were independent predictive factors of DIPs. Surgeons should emphasize the preoperative evaluation of paraspinal muscle and bone mass in DLS patients.
PubMed: 37456299
DOI: 10.21037/qims-22-1394 -
European Spine Journal : Official... Sep 2023This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
PURPOSE
This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time.
METHODS
Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters.
RESULTS
A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSA declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FAT increased. In line with this result, the FI increased in both males (29.9%) and females (19.4%). Females had a higher FI and FI than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSA and fCSA in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FI was observed for both sexes.
CONCLUSION
The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
Topics: Male; Humans; Female; Middle Aged; Low Back Pain; Longitudinal Studies; Psoas Muscles; Lumbar Vertebrae; Lumbosacral Region; Paraspinal Muscles; Magnetic Resonance Imaging
PubMed: 37378708
DOI: 10.1007/s00586-023-07814-1 -
Pain Medicine (Malden, Mass.) Aug 2023The Biospecimen Collection and Processing Working Group of the National Institutes of Health (NIH) HEAL Initiative BACPAC Research Program was charged with identifying...
The Biospecimen Collection and Processing Working Group of the National Institutes of Health (NIH) HEAL Initiative BACPAC Research Program was charged with identifying molecular biomarkers of interest to chronic low back pain (cLBP). Having identified biomarkers of interest, the Working Group worked with the New York University Grossman School of Medicine, Center for Biospecimen Research and Development-funded by the Early Phase Pain Investigation Clinical Network Data Coordinating Center-to harmonize consortium-wide and site-specific efforts for biospecimen collection and analysis. Biospecimen collected are saliva, blood (whole, plasma, serum), urine, stool, and spine tissue (paraspinal muscle, ligamentum flavum, vertebral bone, facet cartilage, disc endplate, annulus fibrosus, or nucleus pulposus). The omics data acquisition and analyses derived from the biospecimen include genomics and epigenetics from DNA, proteomics from protein, transcriptomics from RNA, and microbiomics from 16S rRNA. These analyses contribute to the overarching goal of BACPAC to phenotype cLBP and will guide future efforts for precision medicine treatment.
Topics: Humans; RNA, Ribosomal, 16S; Biomarkers; Low Back Pain; Phenotype; New York
PubMed: 36525387
DOI: 10.1093/pm/pnac197 -
Scientific Reports Jan 2024This study aims to evaluate the impact of percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) on the postoperative paraspinal muscle fat...
This study aims to evaluate the impact of percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) on the postoperative paraspinal muscle fat infiltration (FI) rate in patients with thoracolumbar fractures through magnetic resonance imaging (MRI), and explore the association between paraspinal muscle FI rate and regional kyphosis angle. We retrospectively analyzed clinical data from 35 patients who underwent either PPSF or OPSF for thoracolumbar fractures, examining data at preoperative, 1-month postoperative, and 9-months postoperative time points, which included Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and regional kyphosis angle. We obtained preoperative and 9-month postoperative paraspinal muscle FI rates using T2-weighted MRI images and ImageJ software. We analyzed the correlation of FI rates with VAS, ODI, as well as the correction loss percentage of regional kyphosis angle. The analysis revealed a positive correlation between postoperative FI rate increase and correction loss percentage of regional kyphosis angle (r = 0.696, p < 0.001). The increase in paraspinal muscle FI rate was positively correlated with 9-month postoperative ODI (r = 0.763, p < 0.001). These findings indicate that an increase in postoperative paraspinal muscle FI rate may result in more significant correction loss of regional kyphosis angle and can lead to increased functional impairment in patients.
Topics: Humans; Retrospective Studies; Spinal Fractures; Paraspinal Muscles; Fracture Fixation, Internal; Fractures, Bone; Kyphosis; Lumbar Vertebrae; Treatment Outcome
PubMed: 38287185
DOI: 10.1038/s41598-024-53017-z -
Journal of Neurophysiology Aug 2023Late-onset Pompe disease (LOPD) is characterized by postural abnormalities mainly due to involvement of paraspinal lumbar and abdominal-pelvic muscles. Previous studies...
Late-onset Pompe disease (LOPD) is characterized by postural abnormalities mainly due to involvement of paraspinal lumbar and abdominal-pelvic muscles. Previous studies quantitatively analyzed static upright posture, spatial-temporal parameters, and kinematics of the lower limbs and trunk, considered as single bone segment. Sagittal plane analysis of the spine and whole body during walking has never been investigated in patients with LOPD. The aim of the study was to evaluate sagittal kinematics and imbalance of the spine and whole body in patients with LOPD by three-dimensional (3-D)-motion analysis using an appropriate marker set protocol and introducing innovative kinematic parameters. Seven siblings with LOPD were assessed by 3-D-stereophotogrammetry using the DB-total protocol, which allows to analyze sagittal alignment of whole body. Fourteen age- and sex-matched healthy subjects were used as controls. LOPD group showed a flattening of the spinal curvatures, with a head and neck posteriorization with respect to sacrum, a significant increase of concavity in Heel-S2-Nasion/C7 angles, a rear-position of upper limbs with respect to pelvis, a shorter pendular activity, and a trend of elbow extension during ambulation. Moreover, a significant increase of excursion range in most of sagittal parameters was found. The present study highlighted a specific pathological postural pattern, resembling "man falling backwards," which reveals a biomechanical compensation strategy of patients with LOPD to maintain the balance against the instability of the spinopelvic region, kinematically verified by increase of the excursion ranges. DB-total kinematic parameters might be useful for functional evaluation and for monitoring response to enzyme replacement therapy, rehabilitation project, and disease progression. This study is the first to quantitatively characterize the sagittal spine and whole body posture of patients with late-onset Pompe disease during walking, showing a pathological kinematic pattern defined "man falling backwards." 3-D-motion analysis, with a specific marker set (DB-total protocol) introducing new whole body kinematic parameters, may be useful for accurate functional evaluation and monitoring this rare disease.
Topics: Male; Humans; Glycogen Storage Disease Type II; Biomechanical Phenomena; Spine; Walking; Sacrum; Spinal Curvatures
PubMed: 37380604
DOI: 10.1152/jn.00142.2023 -
European Spine Journal : Official... Dec 2023The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton...
PURPOSE
The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration.
METHODS
Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed.
RESULTS
There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05).
CONCLUSION
Using H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.
Topics: Humans; Low Back Pain; Paraspinal Muscles; Magnetic Resonance Spectroscopy; Magnetic Resonance Imaging; Creatine; Lumbar Vertebrae; Choline
PubMed: 37721604
DOI: 10.1007/s00586-023-07933-9