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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 -
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 -
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 -
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 -
American Journal of Biological... Apr 2022Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically,...
OBJECTIVES
Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically, inconsistencies involving the classification and counting methods obscure accurate assessment of lumbosacral transitional vertebrae. Therefore, we aim to establish more reliable morphological and morphometric methods for differentiating between sacralizations and lumbarizations in clinical and paleontological contexts.
MATERIALS AND METHODS
Using clinical CT data from 145 individuals aged 14-47 years, vertebral counts and the spatial relationship between the sacrum and adjoining bony structures were assessed, while the morphological variation of the sacrum was assessed using geometric morphometrics based on varied landmark configurations.
RESULTS
The prevalence of lumbosacral and sacrococcygeal segmentation anomalies was 40%. Lumbarizations and sacralizations were reliably distinguishable based on the spatial relationship between the iliac crest and the upward or downward trajectory of the linea terminalis on the sacrum. Different craniocaudal orientations of the alae relative to the corpus of the first sacral vertebra were also reflected in the geometric morphometric analyses. The fusion of the coccyx (32%) was frequently coupled with lumbarizations, suggesting that the six-element sacra more often incorporate the coccyx rather than the fifth lumbar vertebra.
CONCLUSIONS
Our approach allowed the consistent identification of segmentation anomalies even in isolated sacra. Additionally, our outcomes either suggest that homeotic border shifts often affect multiple spinal regions in a unidirectional way, or that sacrum length is highly conserved perhaps due to functional constraints. Our results elucidate the potential clinical, biomechanical, and evolutionary significance of lumbosacral transitional vertebrae.
Topics: Humans; Sacrum; Lumbar Vertebrae; Spinal Diseases; Lumbosacral Region; Ilium; Musculoskeletal Abnormalities
PubMed: 36787761
DOI: 10.1002/ajpa.24466 -
The Journal of Physiology Apr 2015
Topics: Animals; Baroreflex; Estrogens; Female; Kidney; Leptin; Lumbosacral Region; Male; Splanchnic Nerves
PubMed: 25828641
DOI: 10.1113/jphysiol.2014.287763 -
Anaesthesia Oct 1980
Topics: Back Pain; Denervation; Humans; Lumbosacral Region
PubMed: 6449879
DOI: 10.1111/j.1365-2044.1980.tb05017.x -
PloS One 2021The vertebral endplate forms a structural boundary between intervertebral disc and the trabecular bone of the vertebral body. As a mechanical interface between the stiff...
The vertebral endplate forms a structural boundary between intervertebral disc and the trabecular bone of the vertebral body. As a mechanical interface between the stiff bone and resilient disc, the endplate is the weakest portion of the vertebral-disc complex and is predisposed to mechanical failure. However, the literature concerning the bone mineral density (BMD) distribution within the spinal endplate is comparatively sparse. The objective of this study is to investigate the three-dimensional (3D) distribution of computed tomography (CT) attenuation across the lumbosacral endplate measured in Hounsfield Units (HU). A total of 308 endplates from 28 cadaveric fresh-frozen lumbosacral spines were used in this study. Each spine was CT-scanned and the resulting DICOM data was used to obtain HU values of the bone endplate. Each individual endplate surface was subdivided into five clinically-relevant topographic zones. Attenuation was analyzed by spinal levels, sites (superior or inferior endplate) and endplate region. The highest HU values were found at the S1 endplate. Comparisons between the superior and inferior endplates showed the HU values in inferior endplates were significantly higher than those in the superior endplates within the same vertebra and the HU values in endplates cranial to the disc were significantly higher than those in the endplates caudal to the disc within the same disc. Attenuation in the peripheral region was significantly higher than in the central region by 32.5%. Regional comparison within the peripheral region showed the HU values in the posterior region were significantly higher than those in the anterior region and the HU values in the left region were significantly higher than those in the right region. This study provided detailed data on the regional HU distribution across the lumbosacral endplate, which can be useful to understand causes of some endplate lesions, such as fracture, and also to design interbody instrumentation.
Topics: Adult; Aged; Female; Humans; Intervertebral Disc; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 34705863
DOI: 10.1371/journal.pone.0259001 -
PloS One 2021High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral...
High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral region. This study aimed at quantifying kinematic differences in dressage horses when ridden in sitting trot-i.e. with additional load applied in the thoracolumbar region-compared with trotting in-hand. Inertial sensors were glued on to the midline of the thoracic (T) and lumbar (L) spine at T5, T13, T18, L3 and middle of the left and right tubera sacrale of ten elite dressage horses (Mean±SD), age 11±1 years, height 1.70±0.10m and body mass 600±24kg; first trotted in-hand, then ridden in sitting trot on an arena surface by four Grand Prix dressage riders. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed factor: exercise condition; covariate: stride time, Bonferroni post hoc correction: P<0.05). Differential roll, pitch and yaw angles between adjacent sensors were calculated. In sitting trot, compared to trotting in-hand, there was increased pitch (mean±S.D), (in-hand, 3.9 (0.5°, sitting trot 6.3 (0.3°, P = <0.0001), roll (in-hand, 7.7 (1.1°, sitting trot 11.6 (0.9°, P = 0.003) and heading values (in-hand, 4.2 (0.8), sitting trot 9.5 (0.6°, P = <0.0001) in the caudal thoracic and lumbar region (T18-L3) and a decrease in heading values (in-hand, 7.1 (0.5°, sitting trot 5.2 (0.3°, P = 0.01) in the cranial thoracic region (T5-T13). Kinematics of the caudal thoracic and lumbar spine are influenced by the rider when in sitting trot, whilst lateral bending is reduced in the cranial thoracic region. This biomechanical difference with the addition of a rider, emphasises the importance of observing horses during ridden exercise, when assessing them as part of a loss of performance assessment.
Topics: Animals; Biomechanical Phenomena; Female; Horses; Lumbosacral Region; Male; Rotation; Running; Thorax
PubMed: 33956858
DOI: 10.1371/journal.pone.0251144 -
Journal of the American Veterinary... Nov 2021A 12-year-old 32-kg neutered female crossbreed dog was treated for a large lumbosacral skin defect.
CASE DESCRIPTION
A 12-year-old 32-kg neutered female crossbreed dog was treated for a large lumbosacral skin defect.
CLINICAL FINDINGS
The dog had sustained multiple, penetrating dog bite wounds to the lumbosacral and gluteal regions 5 days earlier. The referring veterinarian had initiated treatment with amoxicillin-clavulanic acid, which was continued at a dosage of 8.75 mg/kg, SC, every 24 hours at the referral hospital. Examination of the skin defect revealed a large subcutaneous abscess in the dorsal lumbosacral region with draining perimeter tracts at the wound margin. The partial-thickness wound measured 24 × 35 cm and had multifocal regions of necrosis extending caudally from the dorsal aspect of the T11 vertebra to the tail base. The skin defect was bounded by discolored and necrotic skin edges.
TREATMENT AND OUTCOME
The dog underwent extensive soft tissue wound reconstruction. A single, large, meshed full-thickness free skin graft was harvested from the left dorsolateral aspect of the thorax and grafted to the dorsal lumbosacral region, thereby enabling successful closure of the wound defect. Primary healing of the wound eventually occurred, without postoperative complications.
CLINICAL RELEVANCE
Use of a large, meshed full-thickness free skin graft led to a satisfactory outcome for this dog but required challenging postoperative management. Application of single, large, meshed full-thickness free skin grafts may be an option to manage large skin deficits in the lumbosacral area in dogs.
Topics: Animals; Dogs; Female; Lumbosacral Region; Prostheses and Implants; Skin; Skin Transplantation
PubMed: 34757933
DOI: 10.2460/javma.20.06.0331