-
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 -
Folia Morphologica 2021Lumbar facet joints (LFJs) are diarthrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with... (Review)
Review
Lumbar facet joints (LFJs) are diarthrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with multifaceted biomechanical and functional characteristics. They are theorized as structures of crucial clinical significance since their degenerative morphologic alterations are frequently related to emergence of low back pain. Despite the emerging interest in describing LFJs anatomy in recent years, precise description of LFJs innervation remains controversial. In this comprehensive review, anatomy and biomechanical importance of LFJs and associated adjacent extra-articular structures are thoroughly presented. Furthermore, LFJs innervation in respect to current literature data is punctually analysed. Knowledge of anatomy and innervation LFJs of critical importance for clinicians and spine surgeons, so that patients are properly evaluated and related therapeutic procedures are rationally performed.
Topics: Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Zygapophyseal Joint
PubMed: 33084010
DOI: 10.5603/FM.a2020.0122 -
Scientific Reports Apr 2020Lumbar spondylolysis generally occurs in adolescent athletes. Bony union can be expected with conservative treatment, however, the fracture does not heal in some cases....
Lumbar spondylolysis generally occurs in adolescent athletes. Bony union can be expected with conservative treatment, however, the fracture does not heal in some cases. When the fracture becomes a pseudoarthrosis, spondylolysis patients have the potential to develop isthmic spondylolisthesis. A cross-sectional study was performed to determine the incidence of spondylolysis and spondylolisthesis, and to elucidate when and how often spondylolisthesis occurs in patients with or without spondylolysis. Patients undergoing computed tomography (CT) scans of abdominal or lumbar regions for reasons other than low back pain were included (n = 580). Reconstruction CT images were obtained, and the prevalence of spondylolysis and spondylolisthesis were evaluated. Of the 580 patients, 37 patients (6.4%) had spondylolysis. Of these 37 patients, 19 patients (51.4%) showed spondylolisthesis, whereas only 7.4% of non-spondylolysis patients showed spondylolisthesis (p < 0.05). When excluding unilateral spondylolysis, 90% (18/20) of spondylolysis patients aged ≥60 years-old showed spondylolisthesis. None of the patients with isthmic spondylolisthesis had received fusion surgery, suggesting that most of these patients didn't have a severe disability requiring surgical treatment. Our results showed that the majority of bilateral spondylolysis patients aged ≥60 years-old show spondylolisthesis, and suggest that spondylolisthesis occurs very frequently and may develop at a younger age when spondylolysis exists.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Athletes; Child; Cross-Sectional Studies; Disease Progression; Female; Humans; Japan; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Prevalence; Spondylolisthesis; Spondylolysis; Tomography, X-Ray Computed
PubMed: 32317683
DOI: 10.1038/s41598-020-63784-0 -
BioMed Research International 2015The aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and... (Comparative Study)
Comparative Study Randomized Controlled Trial
The aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and who were capable of performing physical exercises. 65 patients diagnosed with lumbar disc were included in the study. The patients were randomly divided into three groups: Group 1 received 10 sessions of high intensity laser to the lumbar region, Group 2 received 10 sessions of ultrasound, and Group 3 received medical therapy for 10 days and isometric lumbar exercises. The efficacy of the treatment modalities was compared with the assessment of the patients before the therapy at the end of the therapy, and in third month after the therapy. Comparing the changes between groups, statically significant difference was observed in MH (mental health) parameter before treatment between Groups 1 and 2 and in MH parameter and VAS score in third month of the therapy between Groups 2 and 3. However, the evaluation of the patients after ten days of treatment did not show significant differences between the groups compared to baseline values. We found that HILT, ultrasound, and exercise were efficient therapies for lumbar discopathy but HILT and ultrasound had longer effect on some parameters.
Topics: Adult; Aged; Female; Humans; Intervertebral Disc Displacement; Laser Therapy; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Ultrasonic Therapy
PubMed: 25883952
DOI: 10.1155/2015/304328 -
The Journal of Manual & Manipulative... Jun 2022Dry needling treatment focuses on restoring normal muscle function in patients with musculoskeletal pain; however, little research has investigated this assertion. Shear... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dry needling treatment focuses on restoring normal muscle function in patients with musculoskeletal pain; however, little research has investigated this assertion. Shear wave elastography (SWE) allows quantification of individual muscle function by estimating both resting and contracted muscle stiffness.
OBJECTIVE
To compare the effects of dry needling to sham dry needling on lumbar muscle stiffness in individuals with low back pain (LBP) using SWE.
METHODS
Sixty participants with LBP were randomly allocated to receive one session of dry needling or sham dry needling treatment to the lumbar multifidus and erector spinae muscles on the most painful side and spinal level. Stiffness (shear modulus) of the lumbar multifidus and erector spinae muscles was assessed using SWE at rest and during submaximal contraction before treatment, immediately after treatment, and 1 week later. Treatment effects were estimated using linear mixed models.
RESULTS
After 1 week, resting erector spinae muscle stiffness was lower in individuals who received dry needling than those that received sham dry needling. All other between-groups differences in muscle stiffness were similar, but non-significant.
CONCLUSION
Dry needling appears to reduce resting erector spinae muscle following treatment of patients with LBP. Therefore, providers should consider the use of dry needling when patients exhibit aberrant stiffness of the lumbar muscles.
Topics: Dry Needling; Elasticity Imaging Techniques; Humans; Low Back Pain; Lumbosacral Region; Paraspinal Muscles
PubMed: 34525901
DOI: 10.1080/10669817.2021.1977069 -
Turkish Neurosurgery 2020To evaluate the factors affecting the clinical and radiological findings of juxtafacet cyst patients.
AIM
To evaluate the factors affecting the clinical and radiological findings of juxtafacet cyst patients.
MATERIAL AND METHODS
Between January 2011 and December 2018, eight patients diagnosed with juxtafacet cyst were reviewed, retrospectively. Patient demographics; signs and symptoms; and neurological examination, radiological, and surgical findings were noted.
RESULTS
The mean age was 54 years (range, 34â€"69 years) with five (62.5%) females and three (37.5%) males. There were nine juxtafacet cysts in eight patients. Five cysts (55.5%) were located at the L3â€"L4 level, two cysts (22.2%) at the L4â€"L5 level, and two cysts (22.2%) at the L5â€"S1 level. In all patients with L3â€"L4 cysts, the intercrest line was intersecting the spinal column at L4 vertebral body level. The most frequent symptoms were back pain and radiculopathy. Magnetic resonance imaging and computerized tomography revealed degenerative facet arthropathy in six patients (75%). Three patients (37.5%) had a medical history of trauma. One patient (12.5%) was treated conservatively. Seven patients (87.5%) were advised to undergo surgical treatment.
CONCLUSION
Degeneration and instability are the main causes of juxtafacet cysts. They are mainly seen at the L4â€"L5 level due to higher movement capacity of this level. But, if the intercrest line intersects the spinal column at higher levels, degeneration and instability risks move to upper levels, and juxtafacet cysts may occur at the L3â€"L4 or upper levels.
Topics: Adult; Aged; Female; Ganglion Cysts; Humans; Intervertebral Disc Degeneration; Lumbosacral Region; Male; Middle Aged; Retrospective Studies; Synovial Cyst
PubMed: 32091121
DOI: 10.5137/1019-5149.JTN.27588-19.2 -
Brazilian Journal of Physical Therapy 2019One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the effect size of stabilization exercises has been previously reported to be small.
DESIGN
Randomized controlled trial.
OBJECTIVE
To investigate the clinical benefit of using neuromuscular electrical stimulation as a supplement to stabilization exercises in patients with chronic low back pain.
METHODS
Thirty participants with chronic low back pain were randomized into a stabilization exercise only group (n=15) or a stabilization exercise plus neuromuscular electrical stimulation group (n=15). The stabilization exercises included abdominal, side support, and quadruped exercises. The neuromuscular electrical stimulation was applied to the lumbar paraspinal muscles for 20min each session. Both groups received their respective interventions twice a week for 6 weeks. Participant eligibility for inclusion was age between 18 and 60 years, body mass index ≤34, chronic low back pain ≥3 months, Numeric Pain Rating Scale ≥3, Modified Oswestry Disability Questionnaire score ≥20 and ability to understand English. Outcome measurements were self-reported neuromuscular electrical stimulation tolerability scale, Modified Oswestry Disability Questionnaire, Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire and paraspinal muscle strength.
RESULTS
The neuromuscular electrical stimulation was reported to be tolerable. There were no significant between-group differences on any of the outcome measures (p>0.05).
CONCLUSIONS
The application of neuromuscular electrical stimulation on the paraspinal muscles was reported to be tolerable. Supplementing stabilization exercises with neuromuscular electrical stimulation did not offer any additional clinical benefit for the chronic low back pain patients.
Topics: Child, Preschool; Electric Stimulation; Exercise Therapy; Humans; Infant; Low Back Pain; Lumbosacral Region; Muscle Strength
PubMed: 30482602
DOI: 10.1016/j.bjpt.2018.10.003 -
Neurology India 2021
Topics: Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Spinal Fusion; Treatment Outcome
PubMed: 34747776
DOI: 10.4103/0028-3886.329539 -
Folia Morphologica 2020Detailed measurement of lumbar spine, despite the many years of study, still provides new information, especially due to low back pain, which is increasing and... (Review)
Review
Detailed measurement of lumbar spine, despite the many years of study, still provides new information, especially due to low back pain, which is increasing and unresolved worldwide health problem. This review includes historical background and evolution of measurement methods. The paper also focused on searching optimal animal model of lumbar spine and summarizes current knowledge and essential tips. In addition, practical application of lumbar metric analysis was presented. This summary is a starting point for further consideration.
Topics: Animals; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Models, Animal
PubMed: 32020579
DOI: 10.5603/FM.a2020.0008 -
British Medical Journal (Clinical... May 1982
Topics: Constriction, Pathologic; Humans; Lumbosacral Region; Spinal Canal; Spinal Diseases
PubMed: 6805616
DOI: 10.1136/bmj.284.6329.1588-a