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International Journal of Environmental... Apr 2021The objective of this study was to assess the cross-sectional areas (CSA) of lumbar paraspinal muscles and their fatty degeneration in adults with degenerative lumbar...
The objective of this study was to assess the cross-sectional areas (CSA) of lumbar paraspinal muscles and their fatty degeneration in adults with degenerative lumbar spondylolisthesis (DLS) diagnosed with chronic radiculopathy, compare them with those of the same age- and sex-related groups with radiculopathy, and evaluate their correlations and the changes observed on magnetic resonance imaging (MRI). This retrospective study included 62 female patients aged 65-85 years, who were diagnosed with lumbar polyradiculopathy. The patients were divided into two groups: 30 patients with spondylolisthesis and 32 patients without spondylolisthesis. We calculated the CSA and fatty degeneration of the erector spinae (ES) and multifidus (MF) on axial T2-weighted magnetic resonance (MR) images from the inferior end plate of the L4 vertebral body levels. The functional CSA (FCSA): CSA ratio, skeletal muscle index (SMI), and MF CSA: ES CSA ratio were calculated and compared between the two groups using an independent t-test. We performed logistic regression analysis using spondylolisthesis as the dependent variable and SMI, FCSA, rFCSA, fat infiltration rate as independent variables. The result showed more fat infiltration of MF in patients with DLS (56.33 vs. 44.66%; = 0.001). The mean FCSA (783.33 vs. 666.22 mm; = 0.028) of ES muscle was a statistically larger in the patients with DLS. The ES FCSA / total CSA was an independent predictor of lumbar spondylolisthesis (odd ratio =1.092, = 0.016), while the MF FCSA / total CSA was an independent protective factor (odd ratio =0.898, = 0.002).
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Retrospective Studies; Spondylolisthesis
PubMed: 33921317
DOI: 10.3390/ijerph18084037 -
Quantitative Imaging in Medicine and... Jan 2020Our study aimed to investigate the feasibility of functional magnetic resonance imaging [blood oxygen level-dependent (BOLD) imaging and T2 mapping] in monitoring the...
BACKGROUND
Our study aimed to investigate the feasibility of functional magnetic resonance imaging [blood oxygen level-dependent (BOLD) imaging and T2 mapping] in monitoring the activation of lumbar paraspinal muscles before and after exercise.
METHODS
The ethics committee of the First Affiliated Hospital of Kunming Medical University approved our study. Both BOLD and T2 mapping of paraspinal muscles were performed in 50 healthy, young volunteers before and after upper-body extension exercises. The movement tasks included upper body flexion and extension using a simple Roman chair. Cross-sectional area (CSA), R2*, and T2 values were measured in various lower-back anatomical regions. The SPSS22.0 statistical software was used to analyze all the data.
RESULTS
Post-exercise CSA and T2 values were higher than those recorded in the pre-exercise session for the three lower-back muscles that were evaluated (iliocostalis, longissimus, and multifidus) (P<0.01). However, R2* values of these muscles were significantly lower after exercise (P<0.01). A significant difference in the R2*, CSA, and T2 values of the iliocostalis occurred between males and females (P<0.05). No statistically significant differences were evident for R2*, CSA, and T2 of the lower-back muscles between L3 and L4 levels, or between the left and right sides. The total CSA of the iliocostalis was higher than that of the multifidus and longissimus (P<0.05).
CONCLUSIONS
BOLD and T2 mapping are feasible non-invasive indirect assessments of lumbar paraspinal muscle activation before and after exercise.
PubMed: 31956534
DOI: 10.21037/qims.2019.10.20 -
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 -
Human Brain Mapping Nov 2022Topographic organisation is a hallmark of vertebrate cortex architecture, characterised by ordered projections of the body's sensory surfaces onto brain systems....
Topographic organisation is a hallmark of vertebrate cortex architecture, characterised by ordered projections of the body's sensory surfaces onto brain systems. High-resolution functional magnetic resonance imaging (fMRI) has proven itself as a valuable tool to investigate the cortical landscape and its (mal-)adaptive plasticity with respect to various body part representations, in particular extremities such as the hand and fingers. Less is known, however, about the cortical representation of the human back. We therefore validated a novel, MRI-compatible method of mapping cortical representations of sensory afferents of the back, using vibrotactile stimulation at varying frequencies and paraspinal locations, in conjunction with fMRI. We expected high-frequency stimulation to be associated with differential neuronal activity in the primary somatosensory cortex (S1) compared with low-frequency stimulation and that somatosensory representations would differ across the thoracolumbar axis. We found significant differences between neural representations of high-frequency and low-frequency stimulation and between representations of thoracic and lumbar paraspinal locations, in several bilateral S1 sub-regions, and in regions of the primary motor cortex (M1). High-frequency stimulation preferentially activated Brodmann Area (BA) regions BA3a and BA4p, whereas low-frequency stimulation was more encoded in BA3b and BA4a. Moreover, we found clear topographic differences in S1 for representations of the upper and lower back during high-frequency stimulation. We present the first neurobiological validation of a method for establishing detailed cortical maps of the human back, which might serve as a novel tool to evaluate the pathological significance of neuroplastic changes in clinical conditions such as chronic low back pain.
Topics: Humans; Somatosensory Cortex; Brain Mapping; Fingers; Magnetic Resonance Imaging; Hand
PubMed: 35979921
DOI: 10.1002/hbm.26052 -
European Spine Journal : Official... Nov 2022To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle...
PURPOSE
To investigate whether (1) there is a difference between patients with normal or sagittal spinal and spinopelvic malalignment in terms of their paraspinal muscle composition and (2) if sagittal malalignment can be predicted using muscle parameters.
METHODS
A retrospective review of patients undergoing posterior lumbar fusion surgery was conducted. A MRI-based muscle measurement technique was used to assess the cross-sectional area, the functional cross-sectional area, the intramuscular fat and fat infiltration (FI) for the psoas and the posterior paraspinal muscles (PPM). Intervertebral disc degeneration was graded for levels L1 to S1. Sagittal vertical axis (SVA; ≥ 50 mm defined as spinal malalignment), pelvic incidence (PI) and lumbar lordosis (LL) were measured, and PI-LL mismatch (PI-LL; ≥ 10° defined as spinopelvic malalignment) was calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the specificity and sensitivity of the FI for predicting sagittal malalignment.
RESULTS
One hundred and fifty patients were analysed. The PI-LL and SVA malalignment groups were found to have a significantly higher FI (PI-LL:47.0 vs. 42.1%; p = 0.019; SVA: 47.7 vs. 41.8%; p = 0.040). ROC analysis predicted sagittal spinal malalignment using FI (cut-off value 42.69%) with a sensitivity of 73.4% and a specificity of 54.1% with an area under the curve of 0.662.
CONCLUSION
Significant differences in the muscle composition between normal and malalignment groups with respect to FI in both sagittal spinal and spinopelvic alignment were found. This work underlines the imminent impact of the paraspinal musculature on the sagittal alignment.
Topics: Humans; Paraspinal Muscles; Lumbar Vertebrae; Lordosis; Lumbosacral Region; Retrospective Studies
PubMed: 36038784
DOI: 10.1007/s00586-022-07351-3 -
Medicina (Kaunas, Lithuania) Jun 2023: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The...
: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. : The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. : The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased ( = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years ( = 0.397 and = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. : Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.
Topics: Aged; Middle Aged; Humans; Female; Lumbar Vertebrae; Paraspinal Muscles; Lumbosacral Region; Spinal Diseases; Pain; Muscular Atrophy; Magnetic Resonance Imaging
PubMed: 37374322
DOI: 10.3390/medicina59061118 -
BMC Musculoskeletal Disorders Jun 2020To evaluate paraspinal back muscles of asymptomatic subjects using qualitative and quantitative analysis on CT and MRI and correlate the results with demographic data. (Comparative Study)
Comparative Study
BACKGROUND
To evaluate paraspinal back muscles of asymptomatic subjects using qualitative and quantitative analysis on CT and MRI and correlate the results with demographic data.
METHODS
Twenty-nine asymptomatic subjects were enrolled prospectively (age: mean 34.31, range 23-50; 14 men, 15 women) from August 2016 to April 2017. Qualitative analysis of muscles was done using Goutallier's system on CT and MRI. Quantitative analysis entailed cross sectional area (CSA) on CT and MRI, Hounsfield unit (HU) on CT, fat fraction using two-point Dixon technique on MRI. Three readers independently analyzed the images; intra- and inter-observer agreements were measured. Linear regression and Spearman's analyses were used for correlation with demographic data.
RESULTS
CSA values were significantly higher in men (p < 0.001). Fat fraction was higher (22.53% vs. 14.35%) and HU lower (36.00 vs. 47.43) in women (p < 0.001). Intra- and inter-observer reliabilities of the two methods were greater than 0.8, except for CSA of L5/S1 on MRI; however, regarding quantitative analysis, decreasing HU and increasing fat fraction were correlated with increasing age, female gender and lower lumbar segment (p < 0.001).
CONCLUSION
MRI and CT can be reliably used for qualitative and quantitative analysis of paraspinal back muscles, regarding fat content. Fat fraction and HU showed highest reliabilities.
Topics: Adiposity; Adult; Female; Healthy Volunteers; Humans; Linear Models; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Atrophy; Paraspinal Muscles; Prospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 32590960
DOI: 10.1186/s12891-020-03432-w -
Journal of Orthopaedic Surgery and... Dec 2022The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and...
The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression.
BACKGROUND
The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy).
METHODS
The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared.
RESULTS
No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively).
CONCLUSIONS
The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.
Topics: Humans; Paraspinal Muscles; Intervertebral Disc Displacement; Lumbosacral Region; Low Back Pain; Muscular Atrophy; Radiculopathy; Magnetic Resonance Imaging; Lumbar Vertebrae; Intervertebral Disc Degeneration
PubMed: 36514168
DOI: 10.1186/s13018-022-03444-3 -
International Journal of Surgery Case... Mar 2022Clear cell sarcoma is a very rare malignant tumor originating from neural crest cells, the tumor most commonly affects the lower limbs but there have been few cases...
BACKGROUND
Clear cell sarcoma is a very rare malignant tumor originating from neural crest cells, the tumor most commonly affects the lower limbs but there have been few cases reported to affect the trunk and para spinal area. Patients with Para spinal sarcoma have a variety of clinical presentations and a variable prognosis depending on several prognostic factors including tumor size.
CASE PRESENTATION
A 14-year-old male patient presented with paraplegia for one month duration and he was diagnosed later on to have a paraspinal clear cell sarcoma at D12-L1 level. A wide local excision was made and patient was referred for oncology treatment. However, the patient came back to the same hospital after two months due to the recurrence of the tumor at the same site.
CONCLUSION
Clear cell sarcoma, although rare, can affect the spine and present with weakness, paraplegia and backache. It also affects people from all age groups and can have a high metastatic rate and a high recurrence rate.
PubMed: 35176583
DOI: 10.1016/j.ijscr.2022.106825 -
World Neurosurgery Mar 2021The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach.... (Review)
Review
OBJECTIVE
The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches.
METHODS
The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented.
RESULTS
The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches.
CONCLUSIONS
The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.
Topics: Brain Stem; Cadaver; Cerebellum; Cranial Fossa, Posterior; Dissection; Dura Mater; Humans; Neurosurgical Procedures; Paraspinal Muscles; Petrous Bone; Pulvinar; Temporal Lobe; Thalamus
PubMed: 33333288
DOI: 10.1016/j.wneu.2020.12.042