Detection of The Lipoatrophy of Lumbar Paraspinal Muscles Semi Quantitatively In Patients With Low Back Pain By TSE-T2W MR Sequence

Abstract

Aim: Our objective, is to investigate the relationship between lumbar paraspinal muscles lipoatrophy and low back pain. Materials and methods: 74 patients with low back pain and 17 healthy volunteers were included in this cross-sectional study. The patients were grouped according to the duration of pain; group I≤ 4 weeks, group II: 4-12 weeks and group III>12 weeks of duration of pain. Their lumbar MR images were visually analyzed for signs of lumbar paraspinal muscles atrophy. The fat content was graded semiquantitatively (grade 0-4) for each muscle as following multifidus, longissimus and psoas muscles. The relationship between fat content and duration of low back pain was assessed and compared with asymptomatic volunteers. Student's t test, Spearman correlation analysis and Kruskal Wallis ANOVA tests were used in the statistical analysis. Results: There were significant correlations between multifidus, longissimus and psoas muscles atrophy and the duration of the low back pain (r=0.311, p=0.007 for psoas; r=0.382, p=0.001 for multifidus and r=0.398, p<0.001 for longissimus muscle). Lipoatrophy of the multifidus, longissimus and psoas muscles were significantly different among the groups (p<0.001, p=0.001, p<0.001 respectively). Lipoatrophy of all muscles were significantly higher in group III than group I and asymptomatic. Conclusion: Paraspinal muscles must be examined as for atrophy in assessing MR images of lumbar spine. In patients with low back pain, knowledge of the lipoatrophy of the paraspinal muscles may be helpful in planning a better rehabilitation. Key words: Back pain, Skeletal muscle, spine, Magnetic resonance imaging

Keywords

• Back pain, Skeletal muscle, spine, Magnetic resonance imaging

Bel Ağrılarında, Paraspinal Kaslardaki Yağlı Atrofinin Tse-T2 Ağırlıklı MR Sekansı ile Yarıkantitatif Olarak Belirlenmesi

Abstract

Amaç: Bel ağrısı ile lomber paraspinal kasların lipoatrofisi arasındaki ilişkinin belirlenmesidir. Gereç ve Yöntem: Bu kesitsel çalışmaya, bel ağrısı bulunan 74 hasta ve 17 sağlıklı gönüllü katıldı. Bel ağrılı olgular, ağrı süresine göre gruplandırıldı. Grup I≤ 4 hafta, grup II= 4-12 hafta grup III, >12 hafta ağrısı olan hastalarda oluştu. Bu hastaların lomber manyetik rezonans (MR) görüntüleri lomber paraspinal kasların atrofi bulguları bakımından değerlendirildi. Her bir kas için yağ içeriği, yarı-kantikatif (evre 0-4) olarak derecelendirildi. Ağrının süresi ile yağ içerikleri arasındaki ilişki asemptomatik gönüllüler ile karşılaştırıldı. Verilerin istatistiksel analizinde, bağımsız gruplarda t testi, Spearman korelasyon analizi ve Kruskal Wallis ANOVA testleri kullanıldı. Bulgular: Multifidus, longissimus ve psoas kaslarında lipoatrofi ile bel ağrısı süresi arasında anlamlı ilişki saptandı (multifidus kasında r=0.382, p=0.001; longissimus kasında r=0.398, p<0.001; psoas kasında r=0.311, p=0.007). Multifidus, longissimus ve psoas kaslarında lipoatrofi ağrı süresine göre gruplar ve asemptomatik grup arasında farklılık gösterdi (sırasıyla p<0.001, p=0.001, p<0.001). İncelenen tüm kaslarda atrofi değerleri grup III'de, grup I ve asemptomatik olgulara göre anlamlı yüksek idi. Sonuç: Lomber vertebranın MR görüntülerinin değerlendirilmesinde paraspinal kasların atrofi bakımından incelenmesi gerekmektedir. Bel ağrısı bulunan hastalarda paraspinal kaslardaki lipoatrofinin bilinmesi, daha iyi rehabilitasyon planlaması yapılmasında faydalı olabilir. Anahtar kelimeler: Bel ağrısı, İskelet kası, Omurga, Manyetik rezonans görüntüleme.

Keywords

• Bel ağrısı, İskelet kası, Omurga, Manyetik rezonans görüntüleme.

References

1. Flicker PL, Fleckenstein JL, Ferry K ve ark. Lumbar muscle usage in chronic low back pain. Magnetic resonance image evaluation. Spine 1993;18:582-6.
2. 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.
3. Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanism. Med Hypotheses. 2007;68:74-80.
4. Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother 2006; 52:79-88.
5. Moffett J, McLean S. The role of physiotherapy in the management of non- specific back pain and neck pain. Rheumatology (Oxford) 2006;45:371-8.
6. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2005;30:2153-63.
7. 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-A:1973-82.
8. 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;232:709-15.

9. Zhao WP, Yoshiharu K, Matsui H, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation. Spine 2000; 17:2191-9.
10. Yoshihara K, Shirai Y, Nakayama Y, Uesaka S. Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine 2001;15:622-6.
11. 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;18:275-8.
12. 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;1:830-6.
13. Hadar H, Gadoth N, Heifetz M. Fatty replacement of lower paraspinal muscles:normal and neuromuscular disorders. Am J Radiol 1983;141:895-8.
14. Hides JA, Richardson CA, Jull GA. Magnetic resonance imaging and ultrasonography of the lumbar multifidus muscle. Comparison of two different modalities. Spine 1995;1:54-8.
15. Mannion AF, Kaser L, Weber E, Rhyner A, Dvorak J, Müntener M. Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. Eur Spine J 2000;9:273-81.
16. Alaranta H, Luoto S, Heliovaara M, Hurri H. Static back endurance and the risk of low back pain. Clin Biomech 1995;10:323-4.
17. Gürsoy S, Şirikçi A, Madenci E, Bayram M. Lomber disk hernili olgularda paraspinal kas alanının fiziksel parametreler ve oswestry sakatlık skoru ile korelasyonu Romatizma,2001;16:154-8.