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Archives of Orthopaedic and Trauma... Jul 2022There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease...
Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease.
INTRODUCTION
There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD).
MATERIALS AND METHODS
One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6 months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal-Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis.
RESULTS
Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6 months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072).
CONCLUSION
The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6 months after microdiscectomy.
Topics: Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Muscular Atrophy; Paraspinal Muscles
PubMed: 33484312
DOI: 10.1007/s00402-021-03754-x -
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 -
Annals of Diagnostic Pathology Aug 2003Melanotic schwannoma is a rare pigmented neural tumor most commonly occurring in the paraspinal region. In a small minority of instances, melanotic schwannoma may have...
Melanotic schwannoma is a rare pigmented neural tumor most commonly occurring in the paraspinal region. In a small minority of instances, melanotic schwannoma may have multiple nodules. Here, a 52-year-old woman is presented with multiple melanotic schwannomas of paraspinal region.
Topics: Antigens, Neoplasm; Biomarkers, Tumor; Diagnosis, Differential; Disease-Free Survival; Female; Humans; Immunohistochemistry; Melanins; Melanoma; Melanoma-Specific Antigens; Middle Aged; Neoplasm Proteins; Neurilemmoma; S100 Proteins; Spinal Neoplasms
PubMed: 12913850
DOI: 10.1016/s1092-9134(03)00073-x -
The Spine Journal : Official Journal of... Dec 2022The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered...
BACKGROUND CONTEXT
The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered and the position of the pelvis is mostly seen as compensatory and not necessarily a possible cause of sagittal imbalance.
PURPOSE
This study aimed to investigate the influence of the posterior paraspinal muscles (PPM, erector spinae, and multifidus) and the psoas muscle on spinopelvic and spinal alignment.
STUDY DESIGN/SETTING
Retrospective cross-sectional study.
PATIENT SAMPLE
Patients undergoing posterior lumbar fusion between 2014 and 2021 for degenerative conditions at a tertiary care center, with preoperative lumbar magnetic resonance imaging (MRI) within 12 months prior the surgery and a preoperative whole spine radiograph were included.
OUTCOME MEASURES
PPM and psoas muscle measurements including the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the amount of intramuscular fat (FAT), and the percentage of fat infiltration (FI). Spinopelvic measurements including lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA).
METHODS
A T2-weighted MRI-based quantitative assessment of the CSA, the fCSA and the amount FAT was conducted, and FI was further calculated. The regions of interest included the psoas muscle and the PPM on both sides at the L4 level that were summarized and normalized by the patient's height (cm/m). LL, PT, SS, PI, and SVA were determined on standing lateral radiographs. Spearman correlation was used to calculate the crude relationship between spinopelvic and muscle parameters. Multiple linear regression models with age, sex, LL, PT, SS, and SVA set as independent variables were established to determine the association with spinal muscle outcome measures.
RESULTS
A total of 150 patients (53.3% female) were included in the final analysis with a median age of 65.6 years and a median BMI of 28.2 kg/m. Significant positive correlations were observed between PT (ρ=0.327), SVA (ρ=0.256) and PI (ρ=0.202) and the FI. Significant negative correlations were detected for the PT and the fCSA (ρ=-0.202) and PT and the fCSA (ρ=-0.191). Furthermore, a negative correlation was seen for PI and SVA and FI. PT (β=0.187; p=.006), SVA (β=0.155; p=.035), age (β=0.468; p<.001) and sex (β=0.235; p<.001) significantly predict FI (corrected R=0.393) as independent variables.
CONCLUSIONS
This study demonstrated the potential role of posterior paraspinal muscles and psoas muscle on pelvic retroversion and elucidated the relation to sagittal spinal malalignment. Although we cannot establish causality, we propose that increasing FI, representing loss of muscular strength, may lead to increased pelvic retroversion and thus might be the initiating point for the development of the sagittal imbalance. These findings might challenge the well-known theory of increased pelvic retroversion being a compensatory mechanism for sagittal spinal balance. Thus, muscular weakness might be a factor involved in the development of sagittal spinal malalignment.
Topics: Humans; Female; Aged; Male; Paraspinal Muscles; Retrospective Studies; Lumbar Vertebrae; Cross-Sectional Studies; Lumbosacral Region; Lordosis; Spinal Fusion
PubMed: 35944826
DOI: 10.1016/j.spinee.2022.07.103 -
Microbiology Spectrum Apr 2016In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke,... (Review)
Review
In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was Exserohilum rostratum, a brown-black soil organism that previously was a rare cause of human infection. Three lots of methylprednisolone were contaminated with mold at NECC; the mold from unopened bottles of methylprednisolone was identical by whole-genome sequencing to the mold that was isolated from ill patients. Early cases manifested as meningitis, some patients suffered posterior circulation strokes, and later cases were more likely to present with localized infection at the injection site, including epidural abscess or phlegmon, vertebral diskitis or osteomyelitis, and arachnoiditis with intradural involvement of nerve roots. Many patients with spinal or paraspinal infection required surgical intervention. Recommendations for treatment evolved over the first few weeks of the outbreak. Initially, combination therapy with liposomal amphotericin B and voriconazole was recommended for all patients; later, combination therapy was recommended only for those who were most ill, and voriconazole monotherapy was recommended for most patients. Among those patients who continued antifungal therapy for at least 6 months, outcomes for most appeared to be successful, although a few patients remain on therapy.
Topics: Antifungal Agents; Ascomycota; Disease Outbreaks; Drug Contamination; Humans; Injections, Epidural; Mycoses; Steroids; United States
PubMed: 27227303
DOI: 10.1128/microbiolspec.EI10-0005-2015 -
Paraspinal interfascial plane blocks: a well-defined novel terminology becomes clinically essential.Regional Anesthesia and Pain Medicine Jan 2020
PubMed: 31937670
DOI: 10.1136/rapm-2019-101247 -
Frontiers in Veterinary Science 2016Describe computed tomographic (CT) anatomy of canine lumbosacral (LS) paraspinal muscles, a method for measuring paraspinal muscle transverse area ratios and asymmetry...
OBJECTIVES
Describe computed tomographic (CT) anatomy of canine lumbosacral (LS) paraspinal muscles, a method for measuring paraspinal muscle transverse area ratios and asymmetry using CT, and application of this method in a small sample of working dogs with versus without LS pain.
METHODS
Published anatomy references and atlases were reviewed and discrepancies were resolved by examination of anatomic specimens and multiplanar reformatted images to describe transverse CT anatomy of LS region paraspinal muscles. Sixteen Belgian malinois military working dogs were retrospectively recruited and assigned to LS pain positive versus negative groups based on medical record entries. A single observer unaware of dog group measured CT transverse areas of paraspinal muscles and adjacent vertebral bodies, in triplicate, for L5-S1 vertebral locations. A statistician compared muscle transverse area ratios and asymmetry at each vertebral location between groups.
RESULTS
The relative coefficient of variation for triplicate CT area measurements averaged 2.15% (N = 16). Multifidus lumborum (L6-7), psoas/iliopsoas (L5-6, L6-7), and sacrocaudalis dorsalis lateralis (L6-7, L7-S1) transverse area ratios were significantly smaller in dogs with LS pain (n = 11) versus without LS pain (n = 5) (p ≤ 0.05). Muscle asymmetry values were not significantly greater in dogs with versus without LS pain.
CLINICAL RELEVANCE
Computed tomographic morphometry of LS region paraspinal muscles is a feasible objective method for use in future evidence-based research studies in working dogs. Potential future research applications include determining whether decreased paraspinal muscle area ratios and/or increased paraspinal muscle asymmetry could be used as markers for preclinical LS pain in stoic dogs or risk factors for other injuries in high performance canine athletes, or determining whether core muscle strengthening exercise prescriptions for dogs with LS pain have an effect on paraspinal muscle area ratios and asymmetry.
PubMed: 27243022
DOI: 10.3389/fvets.2016.00034 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2020To review the evaluation method of paraspinal muscle and its role in lumbar spine diseases, and offer reference for further research on paraspinal muscles.
OBJECTIVE
To review the evaluation method of paraspinal muscle and its role in lumbar spine diseases, and offer reference for further research on paraspinal muscles.
METHODS
The related literature of paraspinal muscle measurement and its role in lumbar spine diseases was reviewed. The evaluation methods of paraspinal muscle were analyzed from the advantages and disadvantages and the role of paraspinal muscle in lumbar spine diseases was summarized.
RESULTS
Radiographic methods are often used to evaluate the atrophy of paraspinal muscle, mainly including CT and MRI. The cross-sectional area and fatty infiltration of paraspinal muscle are two key parameters. Radiographic methods are reproducible and widely applied, but CT has the disadvantage of radiation exposure, while the cost of MRI is high. Besides, more and more researchers focus on the functional evaluation of paraspinal muscle, which mainly includes surface electromyogram analysis and back muscle strength test. The surface electromyogram analysis can quantitatively measure neuromuscular function, but the results could be affected by many influencing factors. The back muscle strength test is simple, but it lacks standardized posture. The atrophy of paraspinal muscle is related to many lumbar spine diseases, while the results of different researches are different.
CONCLUSION
There are many methods to evaluate paraspinal muscles, but there is no unified standard. The role of paraspinal muscle in lumbar spine diseases need to be further studied.
Topics: Electromyography; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles
PubMed: 33191707
DOI: 10.7507/1002-1892.201912120 -
Spine Jun 2002This prospective study compared the electromyographic activities of paraspinal muscles between normal subjects and patients with scoliosis before and after spine fusion. (Clinical Trial)
Clinical Trial
STUDY DESIGN
This prospective study compared the electromyographic activities of paraspinal muscles between normal subjects and patients with scoliosis before and after spine fusion.
OBJECTIVE
To investigate the functional changes of paraspinal muscles before and after spine fusion using surface electromyography.
SUMMARY OF BACKGROUND DATA
Idiopathic scoliosis is a common spine deformity. Surgical correction followed by spine fusion is the basic method of treatment, but the functional changes in paraspinal muscles after spine fusion still are unknown.
METHODS
For this study, 15 healthy subjects and 19 patients with idiopathic scoliosis were recruited. All 19 patients received posterior spine fusion from T2 to T5 to T12. The surface electromyography for normal subjects and for patients before and after spine fusion was recorded bilaterally along the thoracic and lumbar paraspinal muscles for different postures. Root mean square and median frequency values of electromyographic activities were used to compare results between normal subjects and patients with scoliosis before and after spine fusion.
RESULTS
Electromyographic activities showed significant differences between normal control subjects and patients with pre- or postoperative scoliosis. After spine fusion, electromyography showed lower root mean square activity in the thoracic region and higher root mean square activity in the lumbar region. Patients with preoperative scoliosis showed lower median frequency in the thoracic region and higher median frequency in the lumbar region than normal subjects and patients with postoperative scoliosis. The group with preoperative scoliosis showed the least symmetrical paraspinal muscle activity, followed by the postoperative and normal groups.
CONCLUSIONS
Patients with scoliosis present unbalanced electromyographic activity in the paravertebral muscles, which is diminished by spine fusion, but does not return to the values found in normal subjects. The paraspinal muscles in the thoracic region showed lower activity after spine fusion, probably because of atrophy. Higher muscular activity was found in the lumbar region, which may lead to muscle hypertrophy.
Topics: Adolescent; Adult; Analysis of Variance; Electromyography; Female; Humans; Lumbosacral Region; Male; Muscle, Skeletal; Muscular Atrophy; Posture; Prospective Studies; Reference Values; Scoliosis; Signal Processing, Computer-Assisted; Spinal Fusion; Thoracic Vertebrae
PubMed: 12045515
DOI: 10.1097/00007632-200206010-00009 -
Journal of Neurosciences in Rural... 2017The zoonotic infection hydatidosis is caused by the tapeworm cestode, . Though considered endemic in India where association of humans with sheep and dogs form part of...
The zoonotic infection hydatidosis is caused by the tapeworm cestode, . Though considered endemic in India where association of humans with sheep and dogs form part of the livelihood, primary skeletal muscle involvement of the disease is an extremely rare event. We report a case of primary paraspinal hydatidosis with extradural extension causing acute paraplegia. Excision of the cyst and decompression of the cord was done along with albendazole therapy. Paraspinal hydatid disease is a rare entity, and in regions where hydatid disease is endemic, it can be involved in the differential diagnosis of acute compressive myelopathy. Although antihelminthic chemotherapy forms the mainstay of the treatment, surgical intervention forms a major part of the management.
PubMed: 28694639
DOI: 10.4103/jnrp.jnrp_513_16