The Evaluation of The Relationship Between Psoas Muscle Atrophy and Intervertebral Disc and Facet Joint Degeneration in Patients With Lumbar Pain Using Lumbar Spine MRI

Yıl 2022, Cilt: 17 Sayı: 2, 5 - 14, 15.07.2022

Serkan Ünlü , Tuna Şahin

https://doi.org/10.17517/ksutfd.1110771

Öz

Objective: The purpose of the present study was to determine the relationship between psoas muscle lipoatrophy and facet and disc degeneration in patients
with low back pain with lumbar spinal Magnetic Resonance Imaging (MRI).
Material and Methods: A total of 304 patients who had low back pain were included in this retrospective cross-sectional study. The lumbar MRIs of all patients were evaluated for signs of psoas muscle atrophy. Fat content for each muscle was graded semi-quantitatively (Grade 0-4). The disc and facet joint
degenerations of each patient were also graded. Psoas muscle thickness was measured in the mediolateral axial plane parallel to the vertebra.
Results: It was found that the mean right psoas muscle thickness score of the patients was 35.9±7.2 mm on average, and the mean left psoas muscle thickness score was 35.8±7.1 mm. It was also found that 41.8% of the right psoas muscle degeneration was grade 1, 41.1% was grade 2, 33.6% of the left psoas muscle degeneration was grade 1, 45.1% was grade 2, 64.1% of the right facet degeneration was grade 1, 23.4% was grade 2, and 53.9% of the left facet degeneration was grade 1, and 30.3% was grade 2.
Conclusion: When lumbar spine MRI examinations are evaluated, psoas muscles must also be evaluated in terms of atrophy. Indicating psoas muscle lipoatrophy in patients with low back pain may be useful for better rehabilitation planning.

Anahtar Kelimeler

Disc, Facet joint, Low back pain, Magnetic Resonance Imaging, Psoas muscle

Destekleyen Kurum

yok

Teşekkür

We look forward to hearing from you at your earliest convenience. Sincerely, Serkan Ünlğü Department of Radiology Malatya Eğitim ve Araştırma Hastanesi , Malatya Turkey Phone: [phone] Fax Number: E mail: [e-mail]

Bel Ağrısı Şikâyeti Olan Hastalarda Psoas Kas Dejenerasyonunun Disk ve Faset Eklem Dejenerasyonu ile İlişkisinin Lomber MRG ile Ortaya Konması

Öz

Amaç: Bel ağrısı şikâyeti olan hastalarda lomber Manyetik Rezonans (MR) görüntüleme ile psoas kasının lipoatrofisi ile faset ve disk dejenerasyonu arasındaki ilişkinin belirlenmesidir.
Gereç ve Yöntemler: Bu kesitsel çalışmada bel ağrısı bulunan 304 hasta retrospektif olarak incelendi. Bu hastaların lomber MR görüntüleri psoas kasının atrofi bulguları bakımından değerlendirildi. Her bir kas için yağ içeriği, yarı-kantitatif (evre 0-4) olarak derecelendirildi. Her bir hastanın disk ve faset eklem
dejenerasyonları derecelendirildi. Psoas kas kalınlıkları vertebraya paralel olacak şekilde medio-lateral aksiyel planda ölçüldü.
Bulgular: Hastaların sağ psoas kası kalınlığının ortalama 35.9±7.2 mm, sol psoas kası kalınlığının ortalama 35.8±7.1mm olduğu tespit edilmiştir. Ek olarak sağ psoas kası dejenerasyonunun %41.8’inin grade 1, %41.1’inin grade 2 seviyesinde, sol psoas kası dejenerasyonunun %33.6’sının grade 1, %45.1’inin grade 2 seviyesinde, sağ faset dejenerasyonunun %64.1’inin grade 1, %23.4’ünün grade 2 seviyesinde, sol faset dejenerasyonunun %53.9’unun grade 1, %30.3’ünün grade 2 seviyesinde olduğu görülmüştür.
Sonuç: Lomber vertebranın MR görüntülerinin değerlendirilmesinde psoas kasların atrofi bakımından incelenmesi gerekmektedir. Bel ağrısı bulunan hastalarda psoas kasının lipoatrofinin bilinmesi, daha iyi rehabilitasyon planlaması yapılmasında faydalı olabilir.

Anahtar Kelimeler

Disk, Faset eklem, Bel ağrısı, Manyetik rezonans görüntüleme, Psoas kası

Kaynakça

• Moore KL, Dalley AF, Agur AMR.Clinically Oriented Anatomy. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p.508-669.
• He K, Head J, Mouchtouris N, Hines K, Shea P, Schmidt R et al. The implications of paraspinal muscle atrophy in low back pain, thoracolumbar pathology, and clinical outcomes after spine surgery: A review of the literature. Global Spine J. 2020;10(5):657- 666.
• Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976). 1996;21:2763–2769.
• Demoulin C, Crielaard JM, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine. 2007;74:9–13.
• Wan Q, Lin C, Li X, Zeng W, Ma C. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol. 2015;88:20140546
• Diebo BG, Shah NV, Boachie‑Adjei O, Zhu F, Rothenfluh DA, Paulino CB et al. Adult spinal deformity. Lancet 2019;394(10193):160-172.
• Oh CH, Yoon SH. Whole spine disc degeneration survey according to the ages and sex using pfirrmann disc degeneration grades. Korean J Spine. 2017;14(4):148-154.
• Flicker PL, Fleckenstein JL, Ferry K, Payne J, Ward C, Mayer T et al. Lumbar muscle usage in chronic low back pain. Magnetic resonance imaging evaluation. Spine. 1993.18(5);582-586.
• Akı S. Lomber Vertebral Kolonun Fonksiyonel Anatomisi. In: Ed. Erdine S.Ağrı, Güneş Kitabevi, 2000,328-337.
• Gerber C, Meyer DC, Schneeberger AG, Hoppeler H, von Rechenberg B. Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff:an experimental study in sheep. J Bone joint Surg Am 2004;86:1973-1982.
• Pfirrmann CWA, Schmid MR, Zanetti M, Jost B, Gerber C, Hodler J. Assessment of fat contet in supraspinatus muscle with proton MR spectroscopy in asymptomatic volunteers and patients with supraspinatus tendon lesion. Radiology 2004;232:709-715.
• Mc Loughlin RF, D’Arcy EM, Brittain MM, Fitzgerald O, Masterson JB. The significance of fat and muscle areas in the lumbar paraspinal space:a CT study. J Comput Assist Tomogr 1994;18:275- 278.
• Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healty control subjects. Spine 1993;1:830-836.
• Hadar H, Gadoth N, Heifetz M. Fatty replacement of lower Paraspinal muscles:normal and neuromuscular disorders. Am J Radiol 1983;141:895-898.
• Goldwaith JE. The lumbosacral articulation: an explanation of many cases of ‘‘lumbago,’’ ‘‘sciatica’’ and ‘‘paraplegia.’’ Boston Med Surg J 1911;164:365-372.
• Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine 1994;19:801-806.
• Ashton IK, Ashton BA, Gibson SJ, Polak JM, Jaffray DC, Eisenstein SM. Morphological basis for back pain: The demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res 1992;10:72-78.
• el-Bohy A, Cavanaugh JM, Getchell ML, Bulas T, Getchell TV, King AI. Localization of substance P and neurofilament immunoreactive fibers in the lumbar facet joint capsule and supraspinous ligament of the rabbit. Brain Res 1988;460:379-382.
• Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis: assessment of the role played by lumbar facet joint morphology. Spine 1993;18:80-91.
• Adams MA, Hutton WC. The mechanical function of the lumbar apophyseal joints. Spine 1983;8:327-330.
• Vad VB, Cano WG, Basrai D, Lutz GE, Bhat AL. Role of radiofrequency denervation in lumbar zygapophyseal joint synovitis in baseball pitchers: a clinical experience. Pain Phys 2003;6:307- 312.
• Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: Prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998;209:661-666.
• O’Neill C, Owens DK. Lumbar facet joint pain: time to hit the reset button. Spine 2009;9:619-622.
• Martin MD, Boxell CM, Malone DG. Pathophysiology of lumbar disc degeneration: A review of the literature. Neurosurg Focus 2002;13(2):1-6.
• Frymoyer JW: Segmental instability. In Frymoyer JW, (ed): The adult spine. New York: Raven Press, 1991, 1873-1891.
• Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000;55:145-149.
• Wei-Ping Z, Yoshiharu K, Hisao M, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation. Spine 2000;25:2191-2199.
• Flicker PL, Fleckenstein JL, Ferry K, Payne J, Ward C, Mayer T et al. Lumbar muscle usage in chronic low back pain. Magnetic resonance imaging evaluation. Spine. 1993;18(5):582-586.
• Gursoy S, Sirikci A, Madenci E, Bayram M. Lomber disk hernili olgularda paraspinal kas alanının fiziksel parametreler ve oswestry sakatlık skoru ile korelasyonu Romatizma 2001;16:154- 158.
• Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. pain physician. 2016;19(7):985-1000.
• Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84(1004):709-713.