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Insights Into Imaging Jul 2023The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains,... (Review)
Review
The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains, Batson's venous plexus and a rich arterial network. A wide variety of pathologies can occur in the paraspinal region, originating either from paraspinal soft tissues or the vertebral column. The most common paraspinal benign neoplasms include lipomas, fibroblastic tumours and benign peripheral nerve sheath tumours. Tumour-like masses such as haematomas, extramedullary haematopoiesis or abscesses should be considered in patients with suggestive medical histories. Malignant neoplasms are less frequent than benign processes and include liposarcomas and undifferentiated sarcomas. Secondary and primary spinal tumours may present as midline expansile soft tissue masses invading the adjacent paraspinal region. Knowledge of the anatomy of the paraspinal region is of major importance since it allows understanding of the complex locoregional tumour spread that can occur via many adipose corridors, haematogenous pathways and direct contact. Paraspinal tumours can extend into other anatomical regions, such as the retroperitoneum, pleura, posterior mediastinum, intercostal space or extradural neural axis compartment. Imaging plays a crucial role in formulating a hypothesis regarding the aetiology of the mass and tumour staging, which informs preoperative planning. Understanding the complex relationship between the different elements and the imaging features of common paraspinal masses is fundamental to achieving a correct diagnosis and adequate patient management. This review gives an overview of the anatomy of the paraspinal region and describes imaging features of the main tumours and tumour-like lesions that occur in the region.
PubMed: 37466751
DOI: 10.1186/s13244-023-01462-1 -
Pediatric Physical Therapy : the... Oct 2018Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one...
BACKGROUND
Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified.
PURPOSE
This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice.
RESULTS/CONCLUSIONS
The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
Topics: Academies and Institutes; Child; Evidence-Based Practice; Female; Humans; Infant; Male; Paraspinal Muscles; Pediatrics; Range of Motion, Articular; Societies, Medical; Torticollis; United States
PubMed: 30277962
DOI: 10.1097/PEP.0000000000000544 -
Pain Physician 2016Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized... (Review)
Review
BACKGROUND
Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized by a decrease in cross-sectional area and an increase in fat infiltration in the lumbar paraspinal muscles. In addition microscopic changes, such as changes in fiber distribution, might occur. Inconsistencies in results from different studies make it difficult to draw firm conclusions on which structural changes are present in the different types of non-specific LBP. Insights regarding structural muscle alterations in LBP are, however, important for prevention and treatment of non-specific LBP.
OBJECTIVE
The goal of this article is to review which macro- and/or microscopic structural alterations of the lumbar muscles occur in case of non-specific chronic low back pain (CLBP), recurrent low back pain (RLBP), and acute low back pain (ALBP).
STUDY DESIGN
Systematic review.
SETTING
All selected studies were case-control studies.
METHODS
A systematic literature search was conducted in the databases PubMed and Web of Science. Only full texts of original studies regarding structural alterations (atrophy, fat infiltration, and fiber type distribution) in lumbar muscles of patients with non-specific LBP compared to healthy controls were included. All included articles were scored on methodological quality.
RESULTS
Fifteen studies were found eligible after screening title, abstract, and full text for inclusion and exclusion criteria. In CLBP, moderate evidence of atrophy was found in the multifidus; whereas, results in the paraspinal and the erector spinae muscle remain inconclusive. Also moderate evidence occurred in RLBP and ALBP, where no atrophy was shown in any lumbar muscle. Conflicting results were seen in undefined LBP groups. Results concerning fat infiltration were inconsistent in CLBP. On the other hand, there is moderate evidence in RLBP that fat infiltration does not occur, although a larger muscle fat index was found in the erector spinae, multifidus, and paraspinal muscles, reflecting an increased relative amount of intramuscular lipids in RLBP. However, no studies were found investigating fat infiltration in ALBP. Restricted evidence indicates no abnormalities in fiber type in the paraspinal muscles in CLBP. No studies have examined fiber type in ALBP and RLBP.
LIMITATIONS
Lack of clarity concerning patient definitions, exact LBP symptoms, and applied methods.
CONCLUSIONS
The results indicate atrophy in CLBP in the multifidus and paraspinal muscles but not in the erector spinae. No atrophy was shown in RLBP and ALBP. Fat infiltration did not occur in RLBP, but results in CLBP were inconsistent. No abnormalities in fiber type in the paraspinal muscles were found in CLBP.
KEY WORDS
Low back pain, non-specific, chronic, recurrent, acute, muscle structure, fat infiltration, cross-sectional area, fiber type, review.
Topics: Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Muscle, Skeletal; Paraspinal Muscles
PubMed: 27676689
DOI: No ID Found -
Regional Anesthesia and Pain Medicine Jul 2021Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space ("plane") between two discrete fascial layers is the target of needle insertion and... (Review)
Review
Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space ("plane") between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.
Topics: Analgesia; Anesthetics, Local; Fascia; Humans; Nerve Block; Pain Management
PubMed: 34145071
DOI: 10.1136/rapm-2021-102506 -
International Orthopaedics Jun 2012The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics,... (Review)
Review
The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Eleven articles met our search criteria. Three of the patients with acute paraspinal compartmental syndrome treated with fasciotomy had a full recovery and were able to resume skiing after four months. The aetiology of the onset of lumbar paraspinal compartment syndrome is broadly divided into acute and chronic. Lumbar paraspinal compartment syndrome is one of the causes of back pain with diagnostic clinical features which should be considered in the differential diagnosis of a patient with low back pain. Prospective multicentre trials may provide the surgeon with more insight into the diagnosis and management of lumbar paraspinal compartment syndrome.
Topics: Acute Disease; Adult; Aged; Chronic Disease; Compartment Syndromes; Diagnosis, Differential; Fasciotomy; Female; Humans; Low Back Pain; Lumbosacral Region; Male; Middle Aged; Spinal Diseases; Spinal Injuries; Trauma Centers; Young Adult
PubMed: 22038444
DOI: 10.1007/s00264-011-1386-4 -
Journal of Neurological Surgery. Part... Jul 2018The treatment of atrophy or increased fat infiltration of the lumbar paraspinal muscles of patients with back pain, lumbar radiculopathy, or lumbar degenerative... (Review)
Review
OBJECTIVE
The treatment of atrophy or increased fat infiltration of the lumbar paraspinal muscles of patients with back pain, lumbar radiculopathy, or lumbar degenerative kyphosis is controversial. We review the literature on changes in the lumbar paraspinal muscles of these patients.
METHODS
We searched Medline for relevant English-language articles and retrieved 25 articles published from 1993 to 2017 on changes in the lumbar paraspinal muscles; 21 met our study criteria. We categorized each article into three groups: randomized clinical trial, nonrandomized prospective study, or retrospective study.
RESULTS
We found 1 randomized prospective, 3 nonrandomized prospective, and 17 retrospective studies. Atrophies of the multifidus muscle are found at the level of the L5 vertebral body in patients with back pain, lumbar radiculopathy, and lumbar degenerative kyphosis. Increased fat infiltration to the multifidus muscle was found in the patients with lumbar radiculopathy or lumbar degenerative kyphosis. However, there are controversies over fat infiltration to the multifidus muscle in the patients with back pain and the efficiency of a paramedian surgical approach to prevent the atrophy of the multifidus muscle.
CONCLUSIONS
Atrophy of the multifidus muscle was found in patients with back pain, lumbar radiculopathy, and lumbar degenerative kyphosis. There was increased fat infiltration to the multifidus muscle in those patients with lumbar radiculopathy or lumbar degenerative kyphosis.
Topics: Back Pain; Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Spinal Diseases
PubMed: 29660747
DOI: 10.1055/s-0038-1639332 -
International Journal of Environmental... Feb 2022The present study examined the posterior chain muscle excitation in different deadlift variations. Ten competitive bodybuilders (training seniority of 10.6 ± 1.8 years)...
The present study examined the posterior chain muscle excitation in different deadlift variations. Ten competitive bodybuilders (training seniority of 10.6 ± 1.8 years) performed the Romanian (RD), Romanian standing on a step (step-RD), and stiff-leg deadlift (SD) with an 80% 1-RM. The excitation of the gluteus maximus, gluteus medius, biceps femoris, semitendinosus, erector spinae longissimus, and iliocostalis was assessed during both the ascending and descending phases. During the ascending phase, the RMS of the gluteus maximus was greater in the step-RD than in the RD (effect size (ES): 1.70, 0.55/2.84) and SD (ES: 1.18, 0.11/2.24). Moreover, a greater RMS was found in the SD than in the RD (ES: 0.99, 0.04/1.95). The RMS of the semitendinosus was greater in the step-RD than in the RD (ES: 0.82, 0.20/1.44) and SD (ES: 3.13, 1.67/4.59). Moreover, a greater RMS was found in the RD than in the SD (ES: 1.38, 0.29/2.48). The RMS of the longissimus was greater in the step-RD than in the RD (ES: 2.12, 0.89/3.34) and SD (ES: 3.28, 1.78/4.78). The descending phase had fewer differences between the exercises. No further differences between the exercises were found. The step-RD increased the overall excitation of the posterior chain muscles, possibly because of the greater range of movement and posterior muscle elongation during the anterior flexion. Moreover, the RD appeared to target the semitendinosus more than the SD, while the latter excited the gluteus maximus more.
Topics: Electromyography; Humans; Leg; Muscle, Skeletal; Paraspinal Muscles; Resistance Training; Romania
PubMed: 35162922
DOI: 10.3390/ijerph19031903 -
Journal of Neurosurgery. Pediatrics May 2009Arteriovenous malformations (AVMs) within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural AVMs or arteriovenous fistulas have been the... (Review)
Review
Arteriovenous malformations (AVMs) within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural AVMs or arteriovenous fistulas have been the subject of numerous reports, but paraspinal malformations causing venous congestion or hemorrhage in the spinal canal are rare and present special diagnosis and management challenges. The authors review previously published reports on 16 children with paraspinal AVMs. They also describe the 17th case of a child with a paraspinal AVM who presented with a spontaneous spinal epidural hematoma. To the best of the authors' knowledge, there has been no other case of a spinal epidural hematoma associated with a paraspinal AVM. In each of the 17 cases, the vascular lesion was successfully obliterated using endovascular therapy. Embolization with permanent occlusive agents is an effective treatment for these rare but potentially debilitating lesions.
Topics: Adolescent; Arteriovenous Malformations; Child; Child, Preschool; Embolization, Therapeutic; Female; Hematoma, Epidural, Spinal; Humans; Male; Spinal Cord; Spine; Treatment Outcome
PubMed: 19409023
DOI: 10.3171/2009.2.PEDS08427 -
Neurosurgery Clinics of North America Apr 2004Spinal tumors compose a vast heterogeneous group of neoplasms that are classified by origin into vertebral column, spinal canal, or paraspinal region tumors. Tumors with... (Review)
Review
Spinal tumors compose a vast heterogeneous group of neoplasms that are classified by origin into vertebral column, spinal canal, or paraspinal region tumors. Tumors with both intraspinal (intracanalicular) and paraspinal (extracanalicular) components that communicate via an intravertebral foramen are defined as "dumbbell tumors." This article focuses on the characteristics of a few types of paraspinal tumors, with special emphasis on the management of nerve sheath dumbbell tumors.
Topics: Humans; Nerve Sheath Neoplasms; Neurilemmoma; Spinal Nerves
PubMed: 15177320
DOI: 10.1016/j.nec.2004.02.007 -
BMJ Case Reports Mar 2021Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare...
Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare entity, often caused by intense exercise, but also can be a postoperative complication. We present a 60-year-old man with low back pain, numbness in the left lower back and radicular pain in the left lower extremity, which started after a surgery that involved prolonged positioning on the left side 7 years before, and persisted to the day of evaluation. There was an immediate transient rise in the creatine kinase after surgery. Electromyography showed a left lower lumbar-sacral plexopathy and a lumbar spine MRI revealed fatty infiltration of the lower lumbar-sacral paraspinal muscles. The emergence of radicular lower limb pain was likely due to the compression of the proximal portion of lumbar-sacral plexus during the acute stage of rhabdomyolysis.
Topics: Compartment Syndromes; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Paraspinal Muscles; Rhabdomyolysis
PubMed: 33782060
DOI: 10.1136/bcr-2020-236040