-
Surgical and Radiologic Anatomy : SRA Nov 2018The thoracolumbar fascia (TLF) and the erector spinae aponeurosis (ESA) play significant roles in the biomechanics of the spine and could be a source of low back pain....
PURPOSE
The thoracolumbar fascia (TLF) and the erector spinae aponeurosis (ESA) play significant roles in the biomechanics of the spine and could be a source of low back pain. Attachment, collagen fiber direction, size and biomechanical properties of the TLF have been well documented. However, questions remain about the attachment of the TLF and ESA in relation to adjoining tissues in the lumbosacral region. Moreover, quantitative data in relation to the ESA have rarely been examined. The aim of this study was to further investigate the anatomical features of the TLF and ESA and to determine the attachments and sliding areas of the paraspinal compartment through dissection.
MATERIALS AND METHODS
In 10 fresh cadavers (6 females, 4 males, mean age: 77 ± 10 years), we determined (1) the gross anatomy of the ESA and the TLF (attachments and sliding areas) and (2) the structure of the ESA and the TLF (thickness, width, orientation of collagen fibers). The pennation angle between the axis of the ES muscle fibers and the axis of the collagen fibers of the ESA were also measured.
RESULTS
The TLF is an irregular dense connective tissue with a mean thickness of 0.95 mm. The distance between the spinous processes line and the site where the neurovascular bundles pierced the TLF, depending on the vertebral level, ranged from 29 mm at L1 to 75 mm at L3. The ESA constituted a band of regular longitudinally oriented connective fibers (mean thickness: 1.85 mm). Muscles fibers of the ES were strongly diagonally attached to the ESA (mean pennation angle 8° for the iliocostalis and 14° for the longissimus). To a lesser extent, the superficial multifidi were attached to the ESA at the lumbar level close to the midline and at the sacral level.
CONCLUSION
The ESA, at twice the thickness of the pTLF, was the thickest dense connective tissue of the paraspinal compartment. The ESA and the TLF circumscribed subcompartments and sliding areas between the TFL and the lumbar paraspinal muscles, between the ES and the multifidus, and between the longissimus and the iliocostalis.
Topics: Aged; Aponeurosis; Biomechanical Phenomena; Cadaver; Fascia; Female; Humans; Low Back Pain; Lumbosacral Region; Male; Paraspinal Muscles
PubMed: 30171298
DOI: 10.1007/s00276-018-2087-0 -
Clinical Orthopaedics and Related... Nov 2009The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How should the biopsy be placed? (3) How should the biopsy... (Review)
Review
UNLABELLED
The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How should the biopsy be placed? (3) How should the biopsy be performed and which has the greatest diagnostic accuracy? (4) Who should perform the biopsy? (5) What clinical parameters present the greatest diagnostic difficulty? Using PubMed and Google Scholar we performed English-language literature searches of clinical studies reporting biopsy of soft tissue masses. Thirty-two studies met the inclusion criteria but were only able to address three of the five questions the authors had hoped to evaluate. Available evidence suggests open biopsy has the highest diagnostic accuracy over core needle biopsy, which was higher than fine needle aspiration. There was no evidence to address who is best suited to perform the biopsy (general surgeon, orthopaedic surgeon, radiologist, pathologist) in terms of accuracy of diagnosis. Frozen section at the time of biopsy may improve diagnostic accuracy. Diagnostic difficulty was associated with myxoid and round cell neoplasms, infections, and tumors located in the paraspinal region. The limited number of references addressing these issues demonstrated the need for more Level I research in the area of biopsy of soft tissue masses.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Topics: Biopsy, Fine-Needle; Biopsy, Needle; Evidence-Based Medicine; Female; Humans; Male; Musculoskeletal Diseases; Neoplasm Invasiveness; Neoplasm Staging; Randomized Controlled Trials as Topic; Reproducibility of Results; Societies, Medical; Soft Tissue Neoplasms; United States
PubMed: 19597901
DOI: 10.1007/s11999-009-0965-9 -
Regional Anesthesia and Pain Medicine Sep 2021
Topics: Humans; Nerve Block; Paraspinal Muscles
PubMed: 33203711
DOI: 10.1136/rapm-2020-102160 -
Acta Radiologica (Stockholm, Sweden :... Feb 2023Muscle quantification is an essential step in sarcopenia evaluation.
BACKGROUND
Muscle quantification is an essential step in sarcopenia evaluation.
PURPOSE
To develop and evaluate an automated machine learning (ML) algorithm for segmenting the paraspinous muscles on either abdominal or lumbar (L) computed tomography (CT) scans.
MATERIAL AND METHODS
A novel deep neural network algorithm for automated segmentation of paraspinous muscle was developed, CT scans of 504 consecutive patients conducted between January 2019 and February 2020 were assembled. The muscle was manually segmented at L3 vertebra level by three radiologists as ground truth, divided into training and testing subgroups. Muscle cross-sectional area (CSA) was recorded. Dice similarity coefficients (DSCs) and CSA errors were calculated to evaluate system performance. The degree of muscle fat infiltration (MFI) recording by percentage value was the fat area within the region of interest divided by the muscle area. An analysis of the factors influencing the performance of the V-net-based segmentation system was also implemented.
RESULTS
The mean DSCs for paraspinous muscles were high for both the training (0.963, 0.970, 0.941, and 0.968, respectively) and testing (0.950, 0.960, 0.929, and 0.961, respectively) datasets, while the CSA errors were low for both training (1.9%, 1.6%, 3.1%, and 1.3%, respectively) and testing (3.4%, 3.0%, 4.6%, and 1.9%, respectively) datasets. MFI and muscle area index (MI) were major factors affecting DSCs of the posterior paraspinous and paraspinous muscle groups.
CONCLUSION
The ML algorithm for the measurement of paraspinous muscles was compared favorably to manual ground truth measurements.
Topics: Humans; Deep Learning; Paraspinal Muscles; Tomography, X-Ray Computed; Sarcopenia; Lumbar Vertebrae
PubMed: 35354336
DOI: 10.1177/02841851221090594 -
The Spine Journal : Official Journal of... Jul 2016Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the...
BACKGROUND CONTEXT
Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the paraspinal muscles play an important role in spine stability, no study has assessed the relationship between paraspinal muscle atrophy and the incidence of ASD after lumbar fusion.
PURPOSE
In the present study, we aimed to verify the known risk factors of ASD, such as body mass index (BMI), preoperative adjacent facet joint degeneration, and disc degeneration, and to assess the relationship between paraspinal muscle atrophy and ASD.
STUDY DESIGN
This is a retrospective 1:1 pair analysis matched by age, sex, fusion level, and follow-up period.
PATIENT SAMPLE
To calculate the appropriate sample size for the study, we performed a pre-study analysis of the paraspinal muscle cross-sectional area (CSA), and estimated that at least 35 cases would be needed for each group. Among the 510 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 2009 and October 2009, a total of 50 patients with ASD after surgery were selected. Another group of 50 matched patients with degenerative lumbar disease without ASD after spinal fusion were selected as the control group. Each patient in the ASD group was matched with a control patient according to age, sex, fusion level, and follow-up period.
OUTCOME MEASURES
Radiographic measurements and demographic data were reviewed.
METHODS
The risk factors considered were higher BMI, preoperative adjacent segment disc and facet degeneration, and preoperative paraspinal muscle atrophy and fatty degeneration. The radiographic data were compared between the ASD and control groups to determine the predictive factors of ASD after posterior lumbar fusion by using logistic regression analysis. The study was not externally funded. The authors have no conflict of interest to declare.
RESULTS
Multivariate logistic regression analysis indicated that higher BMI (odds ratio [OR]: 1.353, p=.008), preoperative facet degeneration on computed tomography examination (OR: 3.075, p=.011), disc degeneration on magnetic resonance imaging (MRI) (OR: 2.783, p=.003), fatty degeneration (OR: 1.080, p=.044), and a smaller relative CSA of the paraspinal muscle preoperatively (OR: 0.083, p=.003) were significant factors for predicting the development of ASD.
CONCLUSIONS
The occurrence of radiological ASD is most likely multifactorial, and is associated with a higher BMI, preexisting facet and disc degeneration on preoperative examination, and a smaller preoperative relative CSA of the paraspinal muscle on MRI.
Topics: Adult; Female; Humans; Incidence; Intervertebral Disc Degeneration; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Atrophy; Paraspinal Muscles; Postoperative Complications; Radiography; Retrospective Studies; Risk Factors; Spinal Fusion; Tomography, X-Ray Computed; Zygapophyseal Joint
PubMed: 26970600
DOI: 10.1016/j.spinee.2016.03.010 -
Quantitative Imaging in Medicine and... Feb 2020Paraspinal musculature forms one of the largest muscle compartments of the human body, but evidence for regional variation of its composition and dependency on gender or...
BACKGROUND
Paraspinal musculature forms one of the largest muscle compartments of the human body, but evidence for regional variation of its composition and dependency on gender or body mass index (BMI) is scarce.
METHODS
This study applied six-echo chemical shift encoding-based water-fat magnetic resonance imaging (MRI) at 3 Tesla in 76 subjects (24 males and 52 females, age: 40.0±13.7 years, BMI: 25.4±5.6 kg/m) to evaluate the proton density fat fraction (PDFF) of psoas muscles and erector spinae muscles, with the latter being divided into three segments in relation to levels of spine anatomy (L3-L5, T12-L2, and T9-T11).
RESULTS
For the psoas muscles and the erector spinae muscles (L3-L5), gender differences in PDFF values were observed (PDFF psoas muscles: males: 5.1%±3.4% . females: 6.0%±2.2%, P=0.006; PDFF erector spinae muscles L3-L5: males: 10.7%±7.6% . females: 18.2%±6.8%, P<0.001). Furthermore, the PDFF of the erector spinae muscles (L3-L5) showed higher PDFF values when compared to the other segments (PDFF erector spinae muscles L3-L5 . T12-L2: P<0.001; PDFF erector spinae muscles L3-L5 . T9-T11: P<0.001) and showed to be independent of BMI, which was not the case for the other segments (T12-L2 or T9-T11) or the psoas muscles. When considering age and BMI as control variables, correlations of PDFF between segments of the erector spinae muscles remained significant for both genders.
CONCLUSIONS
This study explored regional variation of paraspinal muscle composition and dependency on gender and BMI, thus offering new insights into muscle physiology. The PDFF of the erector spinae muscles (L3-L5) was independent of BMI, suggesting that this level may be suited for representative paraspinal muscle segmentation and PDFF extraction as a biomarker for muscle alterations in the future.
PubMed: 32190574
DOI: 10.21037/qims.2020.01.10 -
Pediatric Radiology Sep 2003A unique case of idiopathic diffuse lipomatosis is reported. The patient was an 11-year-old boy with diffuse lipomatosis in the epidural space, paraspinal muscles, and...
A unique case of idiopathic diffuse lipomatosis is reported. The patient was an 11-year-old boy with diffuse lipomatosis in the epidural space, paraspinal muscles, and thoracolumbar subcutaneous regions. Epidural lipomatosis involved the entire thoracolumbar spine and was associated with filar thickening and lipoma. In addition, paraspinal muscles, especially the erector spinae group, had diffuse fatty infiltration. The ultimate clinical effect of this fatty tissue was urinary dysfunction, radicular pain and hypoesthesia in both legs and difficulty walking.
Topics: Child; Epidural Space; Humans; Lipomatosis; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Muscular Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 12851798
DOI: 10.1007/s00247-003-0977-7 -
World Neurosurgery May 2023Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the...
BACKGROUND
Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level.
METHODS
Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging.
RESULTS
Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively.
CONCLUSIONS
Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.
Topics: Humans; Paraspinal Muscles; Zygapophyseal Joint; Lumbosacral Region; Lumbar Vertebrae; Intervertebral Disc Degeneration; Muscular Atrophy; Magnetic Resonance Imaging
PubMed: 36863453
DOI: 10.1016/j.wneu.2023.02.111 -
BMC Musculoskeletal Disorders Aug 2022The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The...
BACKGROUND
The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The purpose of this study is to determine the age- and sex-dependent differences in the morphology and composition of the paraspinal muscles between LDD and asymptomatic subjects.
METHODS
We analyzed data from 370 patients and 327 asymptomatic volunteers aged between 18-85 years. The measurement of the cross-sectional area (CSA) of the erector spinae, multifidus, and psoas at the L4/5-disc level was performed by the magnetic resonance imaging (MRI). The fatty infiltration ratio (FI %) of the multifidus and erector spinae was calculated.
RESULTS
FI % of the lumbar paraspinal muscles were significantly and positively correlated with the severity of LDD instead of the CSA. Males had greater CSA than females, and females showed higher FI % than males in the paraspinal muscles. With the increase of age, the CSA of the lumbar paraspinal muscles gradually decreased, and the psoas showed the most significant decreasing trend. However, the FI % gradually increased in both LDD and asymptomatic groups with aging.
CONCLUSION
Age- and sex-dependent differences were found in the morphology and composition of the paraspinal muscles between subjects with and without LDD. Further long-term follow up investigations and basic studies will continue to confirm the natural history of the paraspinal muscles with aging and their association with LDD.
Topics: Adipose Tissue; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Paraspinal Muscles; Young Adult
PubMed: 35915426
DOI: 10.1186/s12891-022-05692-0 -
Scientific Reports Aug 2021A combination of magnetic resonance imaging (MRI), computed tomography (CT), and radionuclide cisternography are typically used to locate a cerebrospinal fluid (CSF)...
A combination of magnetic resonance imaging (MRI), computed tomography (CT), and radionuclide cisternography are typically used to locate a cerebrospinal fluid (CSF) leak. However, the site of leakage cannot be determined, making treatment more difficult. Therefore, more sensitive imaging tools are needed. A whole-body [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI was conducted on six patients with suspected CSF leak and the resulting images were reviewed in comparison with those from six healthy controls. Paraspinal regions of focally increased uptake of [18F]FDG were quantified using maximum standardized uptake values (SUV) and compared to the SUV of corresponding regions in the healthy controls. All six patients with suspected CSF leak showed paraspinal regions of significantly greater [18F]FDG uptake compared to the corresponding areas in controls (P < 0.05). Two patients treated with local injections (epidural blood patches and/or epidural fibrin patches) on the site of abnormal PET/MRI findings reported temporary but significant improvement in symptoms. Our results suggest [18F]FDG PET/MRI is sensitive to abnormalities potentially due to suspected CSF leak, which are not necessarily visible on conventional MRI alone or by the standard-of-care imaging methods.
Topics: Adult; Cerebrospinal Fluid Leak; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paraspinal Muscles; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Tomography, X-Ray Computed; Whole Body Imaging
PubMed: 34354104
DOI: 10.1038/s41598-021-95056-w