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World Neurosurgery May 2024The erector spinae plane block (ESPB) is a novel regional analgesic technique which improves postoperative outcomes in lumbar surgery patients including length of...
OBJECTIVE
The erector spinae plane block (ESPB) is a novel regional analgesic technique which improves postoperative outcomes in lumbar surgery patients including length of hospitalization, days to ambulation, and postoperative opioid use. Traditionally, the block is administered by anesthesiologists trained in the ultrasound guidance technique. The use of fluoroscopic guidance may improve the efficiency and accessibility of the ESPB for spine surgeons. We aim to measure the time to administer an ESPB using fluoroscopic guidance and localize the anesthetic using intraoperative three-dimensional (3D) imaging.
METHODS
Two neurosurgeons administered an ESPB to patients undergoing lumbar surgery. Time from insertion of the spinal needle to localize the erector spinae plane using C-arm guidance to time of complete injection and removal of the needle from the skin was recorded. One patient underwent O-arm imaging following injection of an Isovue-Exparel solution at the L3 level to visualize spread of the anesthetic.
RESULTS
A total of 21 patients were enrolled in this study. The average duration to perform an ESPB under fluoroscopic guidance was 1.2 minutes. The Isovue-Exparel solution was injected at the L3 level and was well distributed along the ESP on intraoperative O-arm imaging. The anesthetic dissected the erector spinae muscle from the transverse process at L2, L3, and L4.
CONCLUSIONS
Fluoroscopic guidance allows efficient and appropriate delivery of the anesthetic to the erector spinae plane. Performing an ESPB with fluoroscopic guidance improves efficiency and accessibility of the analgesic technique for spine surgeons, reducing dependence on anesthesiology personnel trained in administering the block.
Topics: Humans; Nerve Block; Fluoroscopy; Female; Male; Lumbar Vertebrae; Middle Aged; Aged; Paraspinal Muscles; Adult; Anesthetics, Local; Imaging, Three-Dimensional
PubMed: 38453008
DOI: 10.1016/j.wneu.2024.02.147 -
Clinical Neurophysiology : Official... May 2024Compare fasciculation rates between amyotrophic lateral sclerosis (ALS) patients and healthy controls in body regions relevant for diagnosing ALS using motor unit MRI...
OBJECTIVE
Compare fasciculation rates between amyotrophic lateral sclerosis (ALS) patients and healthy controls in body regions relevant for diagnosing ALS using motor unit MRI (MUMRI) at baseline and 6 months follow-up, and relate this to single-channel surface EMG (SEMG).
METHODS
Tongue, biceps brachii, paraspinals and lower legs were assessed with MUMRI and biceps brachii and soleus with SEMG in 10 healthy controls and 10 patients (9 typical ALS, 1 primary lateral sclerosis [PLS]).
RESULTS
MUMRI-detected fasciculation rates in typical ALS patients were higher compared to healthy controls for biceps brachii (2.40 ± 1.90 cmminvs. 0.04 ± 0.10 cmmin, p = 0.004), paraspinals (1.14 ± 1.61 cmminvs. 0.02 ± 0.02 cmmin, p = 0.016) and lower legs (1.42 ± 1.27 cmminvs. 0.13 ± 0.10 cmmin, p = 0.004), but not tongue (1.41 ± 1.94 cmminvs. 0.18 ± 0.18 cmmin, p = 0.556). The PLS patient showed no fasciculation. At baseline, 6/9 ALS patients had increased fasciculation rates compared to healthy controls in at least 2 body regions. At follow-up every patient had increased fasciculation rates in at least 2 body regions. The MUMRI-detected fasciculation rate correlated with SEMG-detected fasciculation rates (τ = 0.475, p = 0.006).
CONCLUSION
MUMRI can non-invasively image fasciculation in multiple body regions and appears sensitive to disease progression in individual patients.
SIGNIFICANCE
MUMRI has potential as diagnostic tool for ALS.
Topics: Humans; Amyotrophic Lateral Sclerosis; Male; Female; Middle Aged; Fasciculation; Magnetic Resonance Imaging; Aged; Electromyography; Muscle, Skeletal; Adult; Motor Neurons; Tongue
PubMed: 38448302
DOI: 10.1016/j.clinph.2024.02.016 -
Medicine Mar 2024There are few histological studies on multifidus after lumbar surgery, and it is not clear whether multifidus changes affect the clinical outcome after lumbar surgery....
There are few histological studies on multifidus after lumbar surgery, and it is not clear whether multifidus changes affect the clinical outcome after lumbar surgery. The aim of this study was to investigate the relationship between multifidus changes and clinical outcomes after lumbar surgery. Patients underwent internal fixation removal after lumbar posterior surgery were enrolled. Patients were divided into a low back pain (LBP) group (n = 15) and a non-low back pain (non-LBP) group (n = 10).The Oswestry disability index (ODI) and visual analog scale (VAS) were completed. 18 patients with lumbar fracture surgery were included as the control group. Multifidus morphological changes were observed by hematoxylin and eosin and Masson staining. The expression of TGF-β1 was observed by immunohistochemistry, immunofluorescence and Western blot. The cross-sectional area (CSA) of the multifidus in the non-LBP group and the control group were greater than those in the LBP group. TGF-β1 expression and gray value ratio in the non-LBP group and the control group were lower than those in the LBP group. The multifidus CSA and TGF-β1 expression in multifidus were strongly correlated with ODI and VAS. Patients with LBP after posterior lumbar surgery suffered from atrophy and fibrosis lesions in the multifidus, and the degree of multifidus lesions was closely related to dysfunction and pain, which might be one of the causes of LBP after posterior lumbar surgery.
Topics: Humans; Low Back Pain; Paraspinal Muscles; Transforming Growth Factor beta1; Lumbosacral Region; Pain Measurement
PubMed: 38428866
DOI: 10.1097/MD.0000000000037239 -
Spine Jun 2024Anatomical study.
STUDY DESIGN
Anatomical study.
OBJECTIVE
This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance.
SUMMARY OF BACKGROUND DATA
Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP.
METHODS
An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded.
RESULTS
The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment.
CONCLUSION
The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments.
Topics: Humans; Lumbar Vertebrae; Zygapophyseal Joint; Low Back Pain; Male; Female; Aged; Paraspinal Muscles; Middle Aged; Lumbosacral Region; Clinical Relevance
PubMed: 38420729
DOI: 10.1097/BRS.0000000000004975 -
The Spine Journal : Official Journal of... Jul 2024The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous...
Investigating the associations between lumbar paraspinal muscle health and age, BMI, sex, physical activity, and back pain using an automated computer-vision model: a UK Biobank study.
BACKGROUND CONTEXT
The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous datasets to interrogate the association between muscle health and BP. Computer-vision models have been transformative in this space, enabling the automated quantification of muscle health and the processing of large datasets.
PURPOSE
To investigate the associations between lumbar paraspinal muscle health and age, sex, BMI, physical activity, and BP in a large, heterogenous dataset using an automated computer-vision model.
DESIGN
Cross-sectional study.
PATIENT SAMPLE
Participants from the UK Biobank with abdominal Dixon fat-water MRI (N=9,564) were included (41.8% women, mean [SD] age: 63.5 [7.6] years, BMI: 26.4 [4.1] kg/m) of whom 6,953 reported no pain, 930 acute BP, and 1,681 chronic BP.
OUTCOME MEASURES
Intramuscular fat (IMF) and average cross-sectional area (aCSA) were automatically derived using a computer-vision model for the left and right lumbar multifidus (LM), erector spinae (ES), and psoas major (PM) from the L1 to L5 vertebral levels.
METHODS
Two-tailed partial Pearson correlations were generated for each muscle to assess the relationships between the muscle measures (IMF and aCSA) and age (controlling for BMI, sex, and physical activity), BMI (controlling for age, sex, and physical activity), and physical activity (controlling for age, sex, and BMI). One-way ANCOVA was used to identify sex differences in IMF and aCSA for each muscle while controlling for age, BMI, and physical activity. Similarly, one-way ANCOVA was used to identify between-group differences (no pain, acute BP, and chronic BP) for each muscle and along the superior-inferior expanse of the lumbar spine while controlling for age, BMI, sex, and physical activity (α=0.05).
RESULTS
Females had higher IMF (LM mean difference [MD]=11.1%, ES MD=10.2%, PM MD=0.3%, p<.001) and lower aCSA (LM MD=47.6 mm, ES MD=350.0 mm, PM MD=321.5 mm, p<.001) for all muscles. Higher age was associated with higher IMF and lower aCSA for all muscles (r≥0.232, p<.001) except for LM and aCSA (r≤0.013, p≥.267). Higher BMI was associated with higher IMF and aCSA for all muscles (r≥0.174, p<.001). Higher physical activity was associated with lower IMF and higher aCSA for all muscles (r≥0.036, p≤.002) except for LM and aCSA (r≤0.010, p≥.405). People with chronic BP had higher IMF and lower aCSA than people with no pain (IMF MD≤1.6%, aCSA MD≤27.4 mm, p<.001) and higher IMF compared to acute BP (IMF MD≤1.1%, p≤.044). The differences between people with BP and people with no pain were not spatially localized to the inferior lumbar levels but broadly distributed across the lumbar spine.
CONCLUSIONS
Paraspinal muscle health is associated with age, BMI, sex, and physical activity with the exception of the association between LM aCSA and age and physical activity. People with BP (chronic>acute) have higher IMF and lower aCSA than people reporting no pain. The differences were not localized but broadly distributed across the lumbar spine. When interpreting measures of paraspinal muscle health in the research or clinical setting, the associations with age, BMI, sex, and physical activity should be considered.
Topics: Humans; Female; Male; Middle Aged; Paraspinal Muscles; Aged; Body Mass Index; United Kingdom; Exercise; Cross-Sectional Studies; Age Factors; Magnetic Resonance Imaging; Sex Factors; Lumbosacral Region; Back Pain; Lumbar Vertebrae; Low Back Pain; UK Biobank
PubMed: 38417587
DOI: 10.1016/j.spinee.2024.02.013 -
Frontiers in Physiology 2024Magnetic resonance imaging (MRI) enables direct measurements of muscle volume and quality, allowing for an in-depth understanding of their associations with...
Magnetic resonance imaging (MRI) enables direct measurements of muscle volume and quality, allowing for an in-depth understanding of their associations with anthropometric traits, and health conditions. However, it is unclear which muscle volume measurements: total muscle volume, regional measurements, measurements of muscle quality: intermuscular adipose tissue (IMAT) or proton density fat fraction (PDFF), are most informative and associate with relevant health conditions such as dynapenia and frailty. We have measured image-derived phenotypes (IDPs) including total and regional muscle volumes and measures of muscle quality, derived from the neck-to-knee Dixon images in 44,520 UK Biobank participants. We further segmented paraspinal muscle from 2D quantitative MRI to quantify muscle PDFF and iron concentration. We defined dynapenia based on grip strength below sex-specific cut-off points and frailty based on five criteria (weight loss, exhaustion, grip strength, low physical activity and slow walking pace). We used logistic regression to investigate the association between muscle volume and quality measurements and dynapenia and frailty. Muscle volumes were significantly higher in male compared with female participants, even after correcting for height while, IMAT (corrected for muscle volume) and paraspinal muscle PDFF were significantly higher in female compared with male participants. From the overall cohort, 7.6% (N = 3,261) were identified with dynapenia, and 1.1% (N = 455) with frailty. Dynapenia and frailty were positively associated with age and negatively associated with physical activity levels. Additionally, reduced muscle volume and quality measurements were associated with both dynapenia and frailty. In dynapenia, muscle volume IDPs were most informative, particularly total muscle exhibiting odds ratios (OR) of 0.392, while for frailty, muscle quality was found to be most informative, in particular thigh IMAT volume indexed to height squared (OR = 1.396), both with -values below the Bonferroni-corrected threshold (). Our fully automated method enables the quantification of muscle volumes and quality suitable for large population-based studies. For dynapenia, muscle volumes particularly those including greater body coverage such as total muscle are the most informative, whilst, for frailty, markers of muscle quality were the most informative IDPs. These results suggest that different measurements may have varying diagnostic values for different health conditions.
PubMed: 38370011
DOI: 10.3389/fphys.2024.1288657 -
Obesity Surgery Mar 2024
Randomized Controlled Trial
Assessing Effect of a Regional Block on Quality of Recovery After Bariatric Surgery : Re: Toprak H, et al. Efficacy of the Erector Spinae Plane Block for Quality of Recovery in Bariatric Surgery: a Randomized Controlled Trial. Obes Surg. 2023; 33(9):2640-2651.
Topics: Humans; Obesity, Morbid; Paraspinal Muscles; Nerve Block; Bariatric Surgery; Pain, Postoperative; Analgesics, Opioid; Ultrasonography, Interventional
PubMed: 38315273
DOI: 10.1007/s11695-023-07051-x -
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 -
Journal of Biomechanics Jan 2024It remains unclear whether paraspinal muscle fatty infiltration in low back pain (LBP) is i) solely intramuscular, ii) is lying outside the epimysium between the muscle...
It remains unclear whether paraspinal muscle fatty infiltration in low back pain (LBP) is i) solely intramuscular, ii) is lying outside the epimysium between the muscle and fascial plane (epimuscular) or iii) or combination of both, as imaging studies often use different segmentation protocols that are not thoroughly described. Epimuscular fat possibly disturbs force generation of paraspinal muscles, but is seldomly explored. This project aimed to 1) compare epimuscular fat in participants with and without chronic LBP, and 2) determine whether epimuscular fat is different across lumbar spinal levels and associated with BMI, age, sex and LBP status, duration or intensity. Fat and water lumbosacral MRIs of 50 chronic LBP participants and 41 healthy controls were used. The presence and extent of epimuscular fat for the paraspinal muscle group (erector spinae and multifidus) was assessed using a qualitative score (0-5 scale; 0 = no epimuscular fat and 5 = epimuscular fat present along the entire muscle) and quantitative manual segmentation method. Chi-squared tests evaluated associations between qualitative epimuscular fat ratings and LBP status at each lumbar level. Bivariate and partial spearman's rho correlation assessed relationships between quantitative and qualitative epimuscular fat with participants' characteristics. Epimuscular fat was more frequent at the L4-L5 (X = 13.781, p = 0.017) and L5-S1 level (X = 27.825, p < 0.001) in participants with LBP compared to controls, which was not found for the higher lumbar levels. The total qualitative score (combined from all levels) showed a significant positive correlation with BMI, age, sex (female) and LBP status (r = 0.23-0.55; p < 0.05). Similarly, the total area of epimuscular fat (quantitative measure) was significantly correlated with BMI, age and LBP status (r = 0.26-0.57; p < 0.05). No correlations were found between epimuscular fat and LBP duration or intensity. Paraspinal muscle epimuscular fat is more common in chronic LBP patients. The functional implications of epimuscular fat should be further explored.
Topics: Humans; Female; Low Back Pain; Paraspinal Muscles; Case-Control Studies; Spine; Lumbosacral Region; Magnetic Resonance Imaging; Lumbar Vertebrae
PubMed: 38280825
DOI: 10.1016/j.jbiomech.2024.111928