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Journal of Anatomy Jan 2020Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross-sectional area and... (Review)
Review
Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross-sectional area and muscle volume, may occur in patients with low back pain. This systematic review was conducted to investigate whether patients with low back pain have macroscopic changes in their hip muscle morphology compared with asymptomatic, healthy individuals, based on current evidence. The electronic databases of PubMed/Medline, Ovid, Scopus, Embase , and Google Scholar were searched from the inception to August 31, 2018. We only included full texts of original studies regarding macroscopic morphological alterations, including atrophy and fat infiltration, in hip muscles of patients with low back pain compared with asymptomatic controls. The quality of the included studies was determined using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study. Sixteen comparative observational studies were found eligible to be included in this review. Eleven were classified as high quality and four as moderate quality. The morphological changes in the psoas major, gluteus maximus, gluteus medius, gluteus minimus, and piriformis muscles were assessed in the primary studies. All selected studies were considered B level of evidence studies. The strength of conclusions for the psoas major, gluteal, and piriformis muscles was moderate. The results revealed that there is substantial controversy about the morphological changes in hip muscles in patients with low back pain; however, the majority of high-quality studies concluded that atrophy of hip muscles is evident in patients with low back pain. The psoas major muscle was the most commonly investigated hip muscle for morphological changes. Major methodological limitations of the included studies were identified and discussed. The present systematic review does not include a formal meta-analysis because of very significant differences in the primary studies in terms of study populations and methodologies. Finally, in clinical practice, it is recommended that physical therapists develop exercise programs to improve hip muscle function in patients with low back pain.
Topics: Hip; Humans; Low Back Pain; Muscle, Skeletal; Psoas Muscles
PubMed: 31475359
DOI: 10.1111/joa.13086 -
Orthopaedic Surgery Feb 2022To describe the anatomical feature positioned beneath the psoas muscle at the lateral aspect of the lower lumbar, and to create a new location system to identify the...
OBJECTIVE
To describe the anatomical feature positioned beneath the psoas muscle at the lateral aspect of the lower lumbar, and to create a new location system to identify the risk factors of lateral lumbar interbody fusion.
METHODS
Six cadavers were dissected and analyzed. The anatomy and neurovascular distribution beneath the psoas major from L to S was observed and recorded, with particular focus on the L disc and below. The psoas major surface was divided homogeneously into four parts, from the anterior border of psoas major to the transverse process. The cranial-to-caudal division was from the lower edge of the psoas muscle attachment on the L vertebrae to the upper part of the S vertebrae, and was divided into five segments. Then a grid system was used to create 20 grids on the psoas major surface, from the anterior border of the muscle to the transverse process and from L to superior S , which was used to determine the anatomical structures' distribution and relationship beneath the psoas major.
RESULTS
A cleft was identified beneath the psoas major, from the level of L downwards. It was filled with loose connective tissue and neurovascular structures. We termed it the cleft of psoas major (CPM). The sympathetic trunk, ascending lumbar vein, iliolumbar vessels, obturator nerve, femoral nerve and occasionally the great vessels are contained within the CPM, although there is significant interpersonal variation. The grid system on the psoas major surface helped to identify the anatomical structures in CPM. There was a considerably lower frequency of occurrence of neurovascular structures in the grids of I/II at the L level where can be considered the "safe zones" for the lateral lumbar interbody fusion. In contrast, the distribution of neurovascular structures at the L S level is dense, where the operation risk is high.
CONCLUSION
The CPM exists lateral to the vertebral surface from L and below. Although the occurrence and distribution of neurovascular structures within the CPM is complex and varies greatly, it can provide a potential cavity for visualization during lateral lumbar interbody fusion. Using psoas major as a reference, this novel grid system can be used to identify the risk factors in CPM and thus identify a safe entry point for surgery.
Topics: Femoral Nerve; Humans; Lumbar Vertebrae; Lumbosacral Region; Psoas Muscles; Spinal Fusion
PubMed: 34939336
DOI: 10.1111/os.13180 -
International Journal of Molecular... Apr 2022Duchenne muscular dystrophy (DMD) is a muscle disease characterized by the absence of the protein dystrophin, which causes a loss of sarcolemma integrity, determining...
Duchenne muscular dystrophy (DMD) is a muscle disease characterized by the absence of the protein dystrophin, which causes a loss of sarcolemma integrity, determining recurrent muscle injuries, decrease in muscle function, and progressive degeneration. Currently, there is a need for therapeutic treatments to improve the quality of life of DMD patients. Here, we investigated the effects of a low-intensity aerobic training (37 sessions) on satellite cells, peroxisome proliferator-activated receptor-gamma coactivator (PGC)-1α protein (PGC-1α), and different types of fibers of the psoas muscle from mice (DMD experimental model). Wildtype and mice were randomly divided into sedentary and trained groups ( = 24). Trained animals were subjected to 37 sessions of low-intensity running on a motorized treadmill. Subsequently, the psoas muscle was excised and analyzed by immunofluorescence for dystrophin, satellite cells, myosin heavy chain (MHC), and PGC-1α content. The minimal Feret's diameters of the fibers were measured, and light microscopy was applied to observe general morphological features of the muscles. The training (37 sessions) improved morphological features in muscles from mice and caused an increase in the number of quiescent/activated satellite cells. It also increased the content of PGC-1α in the group. We concluded that low-intensity aerobic exercise (37 sessions) was able to reverse deleterious changes determined by DMD.
Topics: Animals; Disease Models, Animal; Dystrophin; Humans; Mice; Mice, Inbred mdx; Muscle, Skeletal; Muscular Dystrophy, Duchenne; Psoas Muscles; Quality of Life
PubMed: 35562874
DOI: 10.3390/ijms23094483 -
BMC Musculoskeletal Disorders Oct 2022With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely...
BACKGROUND
With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely related to osteoporosis by dual-energy x-ray absorptiometry (DXA) measurement. However, few studies have explored whether the skeletal muscle and adipose tissue index measured at the lumbar spine 3 (L3) level are closely related to bone mineral density (BMD) and can even predict osteoporosis. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are closely related to BMD.
METHODS
A total of 180 participants were enrolled in this study to obtain skeletal muscle index (SMI), psoas muscle index (PMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at L3 levels and divide them into osteoporotic and normal groups based on the T-score of DXA. Spearman rank correlation was used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and BMD. Similarly, spearman rank correlation was also used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and the fracture risk assessment tool (FRAX). Receiver operating characteristic (ROC) was used to analyze the efficacy of SMI, PMI, SFI, VFI, and VSR in predicting osteoporosis.
RESULTS
BMD of L1-4 was closely correlated with SMI, PMI, VFI and VSR (r = 0.199 p = 0.008, r = 0.422 p < 0.001, r = 0.253 p = 0.001, r = 0.310 p < 0.001). BMD of the femoral neck was only correlated with PMI and SFI (r = 0.268 p < 0.001, r = - 0.164 p-0.028). FRAX (major osteoporotic fracture) was only closely related to PMI (r = - 0.397 p < 0.001). FRAX (hip fracture) was closely related to SMI and PMI (r = - 0.183 p = 0.014, r = - 0.353 p < 0.001). Besides, FRAX (major osteoporotic fracture and hip fracture) did not correlate with VFI, SFI, and VSR. SMI and PMI were statistically significant, with the area under the curve (AUC) of 0.400 (95% confidence interval 0.312-0.488 p = 0.024) and 0.327 (95% confidence interval 0.244-0.410 p < 0.001), respectively. VFI, SFI, and VSR were not statistically significant in predicting osteoporosis.
CONCLUSIONS
This study demonstrated that L3-based muscle index could assist clinicians in the diagnosis of osteoporosis to a certain extent, and PMI is superior to SMI in the diagnosis of osteoporosis. In addition, VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well.
Topics: Humans; Osteoporotic Fractures; Psoas Muscles; Risk Factors; Risk Assessment; Osteoporosis; Absorptiometry, Photon; Bone Density; Hip Fractures; Lumbar Vertebrae; Tomography, X-Ray Computed
PubMed: 36280811
DOI: 10.1186/s12891-022-05887-5 -
European Journal of Vascular and... Dec 2016Psoas muscle area (PMA) is a validated surrogate for muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was...
OBJECTIVE
Psoas muscle area (PMA) is a validated surrogate for muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was associated with post-operative mortality after endovascular or open aortic aneurysm repair.
METHODS
A retrospective review was undertaken of patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 at a tertiary vascular center in Montreal, Quebec, Canada. Pre-operative CT scan images were analyzed with the CoreSlicer.com software tool to measure PMA at the axial level of the L4 vertebrae. Measurements were made by two independent observers blinded to clinical data. The primary endpoint was all-cause mortality.
RESULTS
The cohort consisted of 149 patients with a mean age of 75.6 ± 8.8 years. The mean PMA was 24.0 ± 5.8 cm in males, and 14.3 ± 3.1 cm in females. There were 31 deaths over a mean follow-up of 22.4 months. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between PMA and all-cause mortality with a hazard ratio of 0.86 per cm (95% CI 0.79-0.93). Addition of PMA to the model with the clinical covariates resulted in an improvement in C-statistic from 0.57 to 0.67, and BIC from 307 to 301 (with lower BIC values preferred).
CONCLUSIONS
PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair, and may be integrated into the pre-operative risk assessment to optimize care in high-risk frail patients.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis Implantation; Body Composition; Computed Tomography Angiography; Endovascular Procedures; Female; Frail Elderly; Frailty; Health Status; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Predictive Value of Tests; Proportional Hazards Models; Psoas Muscles; Quebec; Retrospective Studies; Risk Assessment; Risk Factors; Tertiary Care Centers; Time Factors; Treatment Outcome
PubMed: 27776940
DOI: 10.1016/j.ejvs.2016.09.011 -
Liver Transplantation : Official... Nov 2014
Topics: Female; Humans; Liver Diseases; Liver Transplantation; Male; Muscle, Skeletal; Psoas Muscles; Sarcopenia
PubMed: 25212893
DOI: 10.1002/lt.23995 -
Magnetic Resonance in Medicine Jan 2020To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting...
PURPOSE
To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting perivascular pathology with minimal injury to the vessel wall.
METHODS
IV-MRI antennas were combined with 2- to 4-mm diameter water-cooled IV-ultrasound ablation catheters for IV-MRI on a 3T clinical MRI scanner. A software interface was developed for monitoring thermal dose with real-time MRI thermometry, and an MRI-guided ablation protocol developed by repeat testing on muscle and liver tissue ex vivo. MRI thermal dose was measured as cumulative equivalent minutes at 43°C (CEM ). The IV-MRI IV-HIFU protocol was then tested by targeting perivascular ablations from the inferior vena cava of 2 pigs in vivo. Thermal dose and lesions were compared by gross and histological examination.
RESULTS
Ex vivo experiments yielded a 6-min ablation protocol with the IV-ultrasound catheter coolant at 3-4°C, a 30 mL/min flow rate, and 7 W ablation power. In 8 experiments, 5- to 10-mm thick thermal lesions of area 0.5-2 cm were produced that spared 1- to 2-mm margins of tissue abutting the catheters. The radial depths, areas, and preserved margins of ablation lesions measured from gross histology were highly correlated (r ≥ 0.79) with those measured from the CEM = 340 necrosis threshold determined by MRI thermometry. The psoas muscle was successfully targeted in the 2 live pigs, with the resulting ablations controlled under IV-MRI guidance.
CONCLUSION
IV-MRI-guided, IV-HIFU has potential as a precision treatment option that could preserve critical blood vessel wall during ablation of nonresectable perivascular tumors or other pathologies.
Topics: Animals; Blood Vessels; Chickens; High-Intensity Focused Ultrasound Ablation; In Vitro Techniques; Liver; Magnetic Resonance Imaging; Muscle, Skeletal; Psoas Muscles; Swine; Temperature; Thermometry; Vena Cava, Inferior
PubMed: 31402512
DOI: 10.1002/mrm.27932 -
Medicina (Kaunas, Lithuania) Apr 2023The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal...
The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal deformities. However, intraoperative lumbar plexus injury may occur. This is a retrospective comparative study to investigate and compare neurological complications between the conventional lateral approach and a modified lateral approach at L4/5. Patients with a lumbar degenerative disease requiring single-level intervertebral fusion at L4/5 were included and categorized into group X and group A. Patients in group X underwent conventional extreme lateral interbody fusion, while those in group A underwent a modified surgical procedure that included splitting of the anterior third of the psoas muscle, which was dilated by the retractor on the anterior third of the intervertebral disc. The incidence of lumbar plexus injury, defined as a decrease of ≥1 grade on manual muscle testing of hip flexors and knee extensors and sensory impairment of the thigh for ≥3 weeks, on the approach side, was investigated. Each group comprised 50 patients. No significant between-group differences in age, sex, body mass index, and approach side were observed. There was a significant between-group difference in intraoperative neuromonitoring stimulation value (13.1 ± 5.4 mA in group X vs. 18.5 ± 2.3 mA in group A, < 0.001). The incidence of neurological complications was significantly higher in group X than in group A (10.0% vs. 0.0%, respectively, < 0.05). In our modified procedure, the anterior third of the psoas muscle was entered and split, and the intervertebral disc could be reached without damaging the lumbar plexus. When performing lumbar surgery using the lateral approach, lumbar plexus injury can be avoided by following surgical indication criteria based on the location of the lumbar plexus with respect to the psoas muscle and changing the transpsoas approach to the intervertebral disc.
Topics: Humans; Psoas Muscles; Retrospective Studies; Traction; Lumbar Vertebrae; Lumbosacral Plexus
PubMed: 37109688
DOI: 10.3390/medicina59040730 -
International Journal of Computer... Feb 2022The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual...
PURPOSE
The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual segmentation is time consuming, two different automated segmentation methods, a generative adversarial network architecture (GAN) and a multi-atlas segmentation (MAS), as well as a combined approach of both, were investigated in terms of accuracy of automated volumetrics in given CT datasets.
MATERIALS AND METHODS
The bilateral PMM was manually segmented by a radiologist in 34 abdominal CT scans, resulting in 68 single 3D muscle segmentations as training data. Three different methods were tested for their ability to generate automated image segmentations: a GAN- and MAS-based approach and a combined approach of both methods (COM). Bilateral PMM volume (PMMV) was calculated in cm by each algorithm for every CT. Results were compared to the corresponding ground truth using the Dice similarity coefficient (DSC), Spearman's correlation coefficient and Wilcoxon signed-rank test.
RESULTS
Mean PMMV was 239 ± 7.0 cm and 308 ± 9.6 cm, 306 ± 9.5 cm and 243 ± 7.3 cm for the CNN, MAS and COM, respectively. Compared to the ground truth the CNN and MAS overestimated the PMMV significantly (+ 28.9% and + 28.0%, p < 0.001), while results of the COM were quite accurate (+ 0.7%, p = 0.33). Spearman's correlation coefficients were 0.38, 0.62 and 0.73, and the DSCs were 0.75 [95%CI: 0.56-0.88], 0.73 [95%CI: 0.54-0.85] and 0.82 [95%CI: 0.65-0.90] for the CNN, MAS and COM, respectively.
CONCLUSION
The combined approach was able to efficiently exploit the advantages of both methods (GAN and MAS), resulting in a significantly higher accuracy in PMMV predictions compared to the isolated implementations of both methods. Even with the relatively small set of training data, the segmentation accuracy of this hybrid approach was relatively close to that of the radiologist.
Topics: Algorithms; Humans; Image Processing, Computer-Assisted; Machine Learning; Psoas Muscles; Tomography, X-Ray Computed
PubMed: 34928445
DOI: 10.1007/s11548-021-02539-2 -
European Journal of Medical Research Apr 2021Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative...
BACKGROUND
Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative intervention targeting identified risk factors could improve postoperative outcome. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM).
METHODS
Data of patients diagnosed with CRLM who underwent liver resection between 2006 and 2016 were analysed. Muscle quantity (psoas muscle index [PMI]), and muscle quality, (average muscle radiation attenuation [AMA] of the psoas), were measured using computed tomography. Changes in PMI and AMA of psoas after surgery were assessed.
RESULTS
A total of 128 patients were analysed; 67 (52%) had surgery-related loss of muscle quantity and 83 (65%) muscle quality loss. Chronic obstructive pulmonary disease (COPD) (P = 0.045) and diabetes (P = 0.003) were risk factors for surgery-related loss of muscle quantity. A higher age (P = 0.002), open resection (P = 0.003) and longer operation time (P = 0.033) were associated with muscle quality loss. Overall survival was lower in patients with both muscle quantity and quality loss compared to other categories (P = 0.049). The rate of postoperative complications was significantly higher in the group with surgery-related loss of muscle quality.
CONCLUSIONS
Risk factors for surgery-related muscle loss were identified. Overall survival was lowest in patients with both muscle quantity and quality loss. Complication rate was higher in patients with surgery-related loss of muscle quality.
Topics: Aged; Colorectal Neoplasms; Colorectal Surgery; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Postoperative Complications; Prognosis; Psoas Muscles; Retrospective Studies; Risk Factors; Sarcopenia; Survival Rate
PubMed: 33892809
DOI: 10.1186/s40001-021-00507-9