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Axial loading and posture cues in contraction of transversus abdominis and multifidus with exercise.Scientific Reports Jul 2020Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the...
Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the effects of axial loading and postural cues on the contraction of transversus abdominis and lumbar multifidus in supine lying using a novel exercise device (GravityFit). Thirty (18 males and 12 females) endurance-trained runners without a history of spinal pain aged 33-55 years were recruited. Magnetic resonance imaging (MRI) was performed under one rest and five exercise conditions, which involved variations in axial loading and postural cues. Whole volume of the abdominal and lumbar paraspinal muscles was imaged and transversus abdominis thickness and length and multifidus anteroposterior and mediolateral thickness measured. Transversus abdominis contraction was greatest in the 'stretch tall plus arm extension' (length, - 15%, P < 0.001; thickness, + 19%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (length, - 16%, P < 0.001; thickness, + 18%, P < 0.001) conditions. The contraction of multifidus was the greatest in the 'arm extension and thoracic cue' (anteroposterior, + 3.0%, P = 0.001; mediolateral, - 4.2%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (anteroposterior, + 6.0%, P < 0.001; mediolateral, - 2.1%, P = 0.022) conditions. This study provides proof-of-principle for an exercise approach that may be used to facilitate the automatically contraction of the transversus abdominis and multifidus muscles. Axial loading of the body, with or without arm loading, most consistently led to contraction of the transversus abdominis and lumbar multifidus muscles, and regional differences existed in the contraction within the muscles.
Topics: Abdominal Muscles; Adult; Female; Humans; Male; Middle Aged; Muscle Contraction; Paraspinal Muscles; Physical Conditioning, Human; Posture; Spinal Injuries; Weight-Bearing; Weightlessness
PubMed: 32665555
DOI: 10.1038/s41598-020-67509-1 -
European Spine Journal : Official... Oct 2022The aim of this study was to determine the effect of age on the psoas and posterior paraspinal muscles (PPM; multifidus muscle and erector spinae) and to evaluate...
PURPOSE
The aim of this study was to determine the effect of age on the psoas and posterior paraspinal muscles (PPM; multifidus muscle and erector spinae) and to evaluate potential sex-related differences.
METHODS
MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the fat area (FAT) and the proportion of intramuscular fat (FI) were conducted on patients undergoing lumbar fusion surgery between 2014 and 2021. The regions of interest were the psoas muscle and the PPM at the superior endplate of L4. The left and right sides of the muscle groups were summarized and normalized by the patient's height (cm/m). The relationships between age and muscular parameters were analyzed stratified by sex.
RESULTS
A total of 195 patients (57.9%female) with a median age of 64.2 years and a body mass index of 28.3 kg/m were analyzed. The CSA was 7.7 cm/m and differed significantly between females and males (p < 0.001); likewise, the fCSA differed significantly between the sexes. The CSA was 18.8 cm/m with no sex-specific differences. Significant differences were found in the FI (males: 41.1% vs. females: 47.9%; p < 0.001), but not in the FI (males: 3.7% vs. females: 4.5%; p = 0.276). Considering the effect of age on FI, a significant positive correlation was observed for the PPMs for both sexes. Only in women, there was a negative correlation between age and CSA (ρ = - 0.248; p = 0.008), FAT (ρ = - 0.421; p < 0.001) and FI (ρ = - 0.371; p < 0.001).
CONCLUSION
This study demonstrated sex-specific differences in spinal muscle morphology in relation to patient age. With increasing age there was a decrease in FI in women only, unlike in the PPMs in which there was increased FI that was significantly higher in women compared to men.
Topics: Female; Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Atrophy; Paraspinal Muscles
PubMed: 35984509
DOI: 10.1007/s00586-022-07346-0 -
BMC Musculoskeletal Disorders Oct 2020Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back...
BACKGROUND
Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back pain and muscle rehabilitation. Ultrasound (US) imaging of the LM muscle is a useful clinical tool which can be used in the assessment of muscle morphology and function. US is widely used due to its portability, cost-effectiveness, and ease-of-use. In order to assess muscle function, quantitative information of the LM must be extracted from the US image by means of manual segmentation. However, manual segmentation requires a higher level of training and experience and is characterized by a level of difficulty and subjectivity associated with image interpretation. Thus, the development of automated segmentation methods is warranted and would strongly benefit clinicians and researchers. The aim of this study is to provide a database which will contribute to the development of automated segmentation algorithms of the LM.
CONSTRUCTION AND CONTENT
This database provides the US ground truth of the left and right LM muscles at the L5 level (in prone and standing positions) of 109 young athletic adults involved in Concordia University's varsity teams. The LUMINOUS database contains the US images with their corresponding manually segmented binary masks, serving as the ground truth. The purpose of the database is to enable development and validation of deep learning algorithms used for automatic segmentation tasks related to the assessment of the LM cross-sectional area (CSA) and echo intensity (EI). The LUMINOUS database is publicly available at http://data.sonography.ai .
CONCLUSION
The development of automated segmentation algorithms based on this database will promote the standardization of LM measurements and facilitate comparison among studies. Moreover, it can accelerate the clinical implementation of quantitative muscle assessment in clinical and research settings.
Topics: Adult; Humans; Low Back Pain; Lumbosacral Region; Musculoskeletal System; Paraspinal Muscles; Ultrasonography
PubMed: 33097024
DOI: 10.1186/s12891-020-03679-3 -
Quantitative Imaging in Medicine and... Jan 2022To investigate the accuracy of qualitative reporting of conventional magnetic resonance imaging (MRI) in the classification of paediatric brain tumours.
BACKGROUND
To investigate the accuracy of qualitative reporting of conventional magnetic resonance imaging (MRI) in the classification of paediatric brain tumours.
METHODS
Preoperative MRI reports of 608 children prior to resection or biopsy of an intracranial lesion were retrospectively reviewed. A total of 550 children had complete radiological and histopathological notes, thereby reaching our inclusion criteria. Concordance between MRI report and final histopathological diagnosis was assessed using an established lexicon derived from the WHO 2016 classification of CNS tumours. Levels of agreement based on cellular origin, tumour type, and tumour grade were evaluated. Diagnostic accuracy, sensitivity, specificity, confidence intervals, and positive and negative predictive values were calculated.
RESULTS
Diagnostic accuracy differed significantly between tumour types and tumour grades. Sensitivities were highest for ependymomas and sellar, pituitary, pineal, and cranial and/or paraspinal nerve tumours (range 80.65-100%). Sensitivity was slightly lower for astrocytic gliomas, oligodendrogliomas, and choroid plexus, neuronal, mixed neuronal-glial, embryonal, and histiocytic tumours (range 63.33-79.59%). Low sensitivities were noted for meningiomas and mesenchymal non-meningothelial, melanocytic, and germ cell tumours (range 0-56.25%). The most correct tumour type predictions were made in the posterior fossa whilst the most incorrect predictions were made in the lobar regions, pineal/tectal plate area, and the supratentorial ventricles.
CONCLUSIONS
This is the largest published series investigating the predictive accuracy of MRI in paediatric brain tumours. We show that diagnostic accuracy varies greatly by tumour type and location. Looking forward, we should develop and leverage computational methods to improve accuracy in the tumour types and anatomical locations where qualitative diagnostic accuracy is lower.
PubMed: 34993066
DOI: 10.21037/qims-20-1388 -
European Journal of Anaesthesiology Aug 2021Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even... (Observational Study)
Observational Study
BACKGROUND
Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity.
OBJECTIVE
The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials.
DESIGN
Prospective observational study.
SETTING
A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland.
PATIENTS
Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent.
INTERVENTIONS
To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP.
MAIN OUTCOME MEASURES
The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP.
RESULTS
Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal muscles reflect muscle relaxation similar to TOF testing.
CONCLUSION
Hand TOF is superior to foot TOF in assessing muscle relaxation during spinal surgery. Hand TOF adequately represents the degree of muscle relaxation not only for the paraspinal muscles but also for all orthopaedic surgical sites where NMB is crucial for good surgical conditions.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT03318718).
Topics: Evoked Potentials, Motor; Humans; Muscle Relaxation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Switzerland
PubMed: 33259448
DOI: 10.1097/EJA.0000000000001398 -
BMC Musculoskeletal Disorders Dec 2021The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases.
BACKGROUND
The aim of this study was to analyze the effect of unilateral K-rod dynamic internal fixation on paraspinal muscles for lumbar degenerative diseases.
METHODS
This study retrospectively collected 52 patients who underwent lumbar surgery with the K-rod group or PLIF. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative exercise time were compared in the two groups. The visual analog scale (VAS) score and the oswestry dysfunction index (ODI) were employed to evaluate the clinical outcomes. The functional cross-sectional area (FCSA) of the paraspinal muscles and paraspinal muscles fat infiltration were measured to assess on the paraspinal muscles.
RESULTS
As compared with the PLIF group, the operation time, the postoperative time in the field, and the average postoperative hospital stay in the K-rod internal fixation group were significantly shortened. At the last follow-up, both the groups showed significant improvement in the VAS score and ODI. The FCSA atrophy of the upper and lower adjacent segments (UAS and LAS) of the K-rod internal group was significantly less than that of the PLIF group. The extent of increase in the fatty infiltration of the paraspinal muscles in the K-rod group was significantly lesser than that in the PLIF group. The postoperative low back pain of the two groups of patients was significantly positively correlated with the FCSA atrophy.
CONCLUSIONS
As compared to PLIF, the posterior lumbar unilateral K-rod dynamic internal fixation showed significantly lesser paraspinal muscle atrophy and fatty infiltration, which were significantly positively correlated with postoperative low back pain.
Topics: Fracture Fixation, Internal; Humans; Lumbosacral Region; Paraspinal Muscles; Postoperative Period; Retrospective Studies
PubMed: 34930199
DOI: 10.1186/s12891-021-04943-w -
BMJ Open Sep 2019Sarcopenia in the lumbar paraspinal muscles is receiving renewed attention as a cause of spinal degeneration. However, there are few studies on the precise concept and...
Natural aging course of paraspinal muscle and back extensor strength in community-dwelling older adults (sarcopenia of spine, SarcoSpine): a prospective cohort study protocol.
INTRODUCTION
Sarcopenia in the lumbar paraspinal muscles is receiving renewed attention as a cause of spinal degeneration. However, there are few studies on the precise concept and diagnostic criteria for spinal sarcopenia. Here, we develop the concept of spinal sarcopenia in community-dwelling older adults. In addition, we aim to observe the natural ageing process of paraspinal and back muscle strength and investigate the association between conventional sarcopenic indices and spinal sarcopenia.
METHODS AND ANALYSIS
This is a prospective observational cohort study with 120 healthy community-dwelling older adults over 4 years. All subjects will be recruited in no sarcopenia, possible sarcopenia or sarcopenia groups. The primary outcomes of this study are isokinetic back muscle strength and lumbar paraspinal muscle quantity and quality evaluated using lumbar spine MRI. Conventional sarcopenic indices and spine specific outcomes such as spinal sagittal balance, back performance scale and Sorenson test will also be assessed.
ETHICS AND DISSEMINATION
Before screening, all participants will be provided with oral and written information. Ethical approval has already been obtained from all participating hospitals. The study results will be disseminated in peer-reviewed publications and conference presentations.
TRIAL REGISTRATION NUMBER
NCT03962530.
Topics: Aged; Aged, 80 and over; Aging; Female; Geriatric Assessment; Humans; Magnetic Resonance Imaging; Male; Muscle Strength; Observational Studies as Topic; Paraspinal Muscles; Prospective Studies; Research Design; Sarcopenia; Spine
PubMed: 31492798
DOI: 10.1136/bmjopen-2019-032443 -
BMC Musculoskeletal Disorders Nov 2023There is an increasing interest in assessing paraspinal morphology and composition in relation to low back pain (LBP). However, variations in methods and segmentation...
BACKGROUND
There is an increasing interest in assessing paraspinal morphology and composition in relation to low back pain (LBP). However, variations in methods and segmentation protocols contribute to the inconsistent findings in the literature. We present an on-line resource, the ParaspInaL muscLe segmentAtion pRoject (PILLAR, https://projectpillar.github.io/ ), to provide a detailed description and visual guide of a segmentation protocol by using the publicly available ITK-SNAP software and discuss related challenges when performing paraspinal lumbar muscles segmentations from magnetic resonance imaging (MRI).
METHODS
T2-weighted and corresponding fat-water IDEAL axial MRI from 3 males and 3 females (2 chronic LBP and 1 control for each sex) were used to demonstrate our segmentation protocol for each lumbar paraspinal muscle (erector spinae, lumbar multifidus, quadratus lumborum and psoas) and lumbar spinal level (L1-L5).
RESULTS
Proper segmentation requires an understanding of the anatomy of paraspinal lumbar muscles and the variations in paraspinal muscle morphology and composition due to age, sex, and the presence of LBP or related spinal pathologies. Other challenges in segmentation includes the presence and variations of intramuscular and epimuscular fat, and side-to-side asymmetry.
CONCLUSION
The growing interest to assess the lumbar musculature and its role in the development and recurrence of LBP prompted the need for comprehensive and easy-to-follow resources, such as the PILLAR project to reduce inconsistencies in segmentation protocols. Standardizing manual muscle measurements from MRI will facilitate comparisons between studies while the field is progressively moving towards the automatization of paraspinal muscle measurements for large cohort studies.
Topics: Male; Female; Humans; Paraspinal Muscles; Lumbar Vertebrae; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging
PubMed: 37996857
DOI: 10.1186/s12891-023-07029-x -
Journal of Orthopaedic Surgery and... Aug 2021Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral...
BACKGROUND
Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral fractures after VA is controversial. Various factors have been discussed in the literature, but no convincing study on the quality of paraspinal muscles has been reported. The purposes of this study were to evaluate the changes in paraspinal muscles and discuss the relationship between paraspinal muscle degeneration and vertebral refractures after percutaneous kyphoplasty (PKP).
METHODS
This retrospective study was conducted in patients who underwent PKP for an initial OVCF between July 2017 and August 2018. Patients were followed up and categorized in the refractured or non-refractured group. A final magnetic resonance imaging (MRI) scan and a preoperative MRI scan were used to determine the measurements. The paraspinal muscles at the mid-height level of the initial fractured vertebral body were measured using regions of interest (ROIs), including the cross-sectional area (CSA) and signal intensity (SI). The changes in the observed data were compared between the groups using rank-sum tests.
RESULTS
Overall, 92 patients were enrolled in the study; 33 of them sustained vertebral refractures during the follow-up and the other 59 patients did not. There were no significant differences in terms of sex, age, preoperative bone mineral density, and body mass index between the groups (all, P > 0.05). The refractured group had a significantly higher decrease in the ROI-CSA and CSA/SI, and a higher increase in ROI-SI, compared with the preoperative data (all, P < 0.05).
CONCLUSIONS
The quality of paraspinal muscles significantly decreased in patients with new OVCFs after PKP. This brings a new perspective to the study of postoperative recurrent fractures; patients and physicians need to pay more attention to the efficacy of bed rest and bracing.
Topics: Fractures, Compression; Humans; Kyphoplasty; Magnetic Resonance Imaging; Muscular Atrophy; Osteoporotic Fractures; Paraspinal Muscles; Retrospective Studies; Spinal Fractures
PubMed: 34344407
DOI: 10.1186/s13018-021-02623-y -
BMC Musculoskeletal Disorders Mar 2020To compare standalone oblique lateral interbody fusion (OLIF) vs. OLIF combined with posterior bilateral percutaneous pedicle screw fixation (OLIF combined) for the... (Comparative Study)
Comparative Study
BACKGROUND
To compare standalone oblique lateral interbody fusion (OLIF) vs. OLIF combined with posterior bilateral percutaneous pedicle screw fixation (OLIF combined) for the treatment of lumbar spondylolisthesis.
METHODS
This was a retrospective study of patients who underwent standalone OLIF or combined OLIF between 07/2014 and 08/2017 at two hospitals in China. Direct decompressions were not performed. Visual analog scale (VAS), Oswestry Disability Index (ODI), satisfaction rate, anterior/posterior disc heights (DH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, fusion rate, and complications were analyzed. All imaging examinations were read independently by two physicians and the mean measurements were used for analysis.
RESULTS
A total of 73 patients were included: 32 with standalone OLIF and 41 with combined OLIF. The total complication rate was 25.0% with standalone OLIF and 26.8% with combined OLIF. There were no differences in VAS and ODI scores by 2 years of follow-up, but the scores were better with standalone OLIF at 1 week and 3 months (P < 0.05). PDH and FW was smaller in the combined OLIF group compared with the standalone OLIF group before and after surgery (all P < 0.05). There were significant differences in FH before surgery and at 1 week and 3 months between the two groups (all P < 0.05), but the difference disappeared by 2 years (P = 0.111). Cage subsidence occurred in 7.3% (3/41) and 7.3% (3/41) of the patients at 3 and 24 months, respectively, in the combined OLIF group, compared with 6.3% (2/32) and 15.6% (5/32), respectively, in the standalone OLIF group at the same time points (P = 0.287). There was no cage retropulsion in both groups at 2 years. The fusion rate was 85.4%(35/41) in the combined OLIF group and 84.4% (27/32) in the standalone OLIF group at 3 months(P = 0.669). At 24 months, the fusion rate was 100.0% in the combined OLIF group and 93.8% (30/32) in the standalone OLIF group (P = 0.066).
CONCLUSION
Standalone OLIF may achieve equivalent clinical and radiological outcomes than OLIF combined with fixation for spondylolisthesis. The rate of complications was similar between the two groups. Patients who are osteoporotic might be better undergoing combined rather than standalone OLIF. The possibilty of proof lies within a future prospective study, preferably an RCT.
Topics: Aged; China; Female; Humans; Internal Fixators; Intraoperative Complications; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Paraspinal Muscles; Pedicle Screws; Radiography; Retrospective Studies; Spinal Fusion; Spondylolisthesis
PubMed: 32293389
DOI: 10.1186/s12891-020-03192-7