The Effect of the Paraspinal Muscles on Lumbar Disc Herniation
Objectives: Lumbar disc degeneration is diagnosed with radiological signs in the paraspinal muscles (PSM) seen on lumbar magnetic resonance imaging. It is associated with body weight, height, and a high body mass index (BMI). The role of the PSM has not been examined in the literature. The aim of this study was to analyze hernia grading, bilateral PSM length, and BMI.
Methods: The grading of herniation size and the anteroposterior (AP) length of the bilateral PSM and their distance to the skin was assessed at lumbar intervertebral levels in 70 patients with low back pain. Data collected were the bilateral AP lengths of the psoas and PS erector muscle group, Modic type endplate degeneration, and hernia grade at each intervertebral level from L1 to S1. Patients’ age, sex, and BMI were also recorded.
Results: The hernia grades 0-1 were common at the L1-L2, L2-L3, and L3-L4 levels with statistical significance, and hernia grades 2-3 were common at the L4-L5 and L5-S1 levels. The mean age of the patients with a normal BMI was lower than that of the patients who were overweight or obese. The mean age was associated with hernia grade only at the L2-L3 and L3-L4 levels, and it was also related to the right side AP length of the PSM at the L2-L3 and bilateral psoas to skin distance at L3-L4. BMI was not associated with any AP length of bilateral PSM except at the L5-S1 level. There was a correlation between hernia grade 0 and AP length of the right PSM at the L2-L3 level and the left PSM at the L4-L5 level.
Conclusion: PSM atrophy was not related to the severity of hernia or pain, and control of BMI may be effective for hernia. Further studies are required to confirm a possible relationship between the PSM and lumbar disc hernia.
1.Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999;354:581–5. [CrossRef]
2. Parkkola R, Rytökoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976) 1993;18:830–6. [CrossRef]
3. Güler M, Çapkın E, Barcak OF, Karkucak M, Aydın T, Türkyılmaz AK, et al. The association between radiographic features in patients with lumbar spine degenerative changes and body mass index; a preliminary stereological study. Nobel Medicus 2013;9:9–13.
4. Kalichman L, Guermazi A, Li L, Hunter DJ. Association between age, sex, BMI and CT-evaluated spinal degeneration features. J Back Musculoskelet Rehabil 2009;22:189–95. [CrossRef]
5. Samartzis D, Karppinen J, Chan D, Luk KD, Cheung KM. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum 2012;64:1488–96. [CrossRef]
6. Heliövaara M. Body height, obesity, and risk of herniated lumbar intervertebral disc. Spine (Phila Pa 1976) 1987;12:469– 72. [CrossRef]
7. Fortin M, Videman T, Gibbons LE, Battié MC. Paraspinal muscle morphology and composition: a 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc 2014;46:893– 901. [CrossRef]
8. Gibbons LE, Videman T, Battié MC, Kaprio J. Determinants of paraspinal muscle cross-sectional area in male monozygotic twins. Phys Ther 1998;78:602–10. [CrossRef]
9. Okada E, Matsumoto M, Ichihara D, Chiba K, Toyama Y, Fujiwara H, et al. Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study. Eur Spine J 2011;20:1567–73. [CrossRef]
10. Peltonen JE, Taimela S, Erkintalo M, Salminen JJ, Oksanen A, Kujala UM. Back extensor and psoas muscle cross-sectional area, prior physical training, and trunk muscle strength-a longitudinal study in adolescent girls. Eur J Appl Physiol Occup Physiol 1998;77:66–71. [CrossRef]
11. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008;13:43–9. [CrossRef]
12. Fortin M, Lazáry À, Varga PP, McCall I, Battié MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J 2016;25:1452–9. [CrossRef]
13. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 2007;5:2. [CrossRef]
14. Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 2006;240:786–92. [CrossRef]
15. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000;9:266–72. [CrossRef]
16. Cooper RG, St Clair Forbes W, Jayson MI. Radiographic demon-stration of paraspinal muscle wasting in patients with chronic low back pain. Br J Rheumatol 1992;31:389–94. [CrossRef]
17. Battié MC, Niemelainen R, Gibbons LE, Dhillon S. Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J 2012;12:932–9. [CrossRef]
18. 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;84:709–13. [CrossRef]
19. Mattila M, Hurme M, Alaranta H, Paljärvi L, Kalimo H, Falck B, et al. The multifidus muscle in patients with lumbar disc herniation. A histochemical and morphometric analysis of intraoperative biopsies. Spine (Phila Pa 1976) 1986;11:732–8.
20. Lee HI, Song J, Lee HS, Kang JY, Kim M, Ryu JS. Association between Cross-sectional Areas of Lumbar Muscles on Magnetic Resonance Imaging and Chronicity of Low Back Pain. Ann Rehabil Med 2011;35:852–9. [CrossRef]
21. Pye SR, Reid DM, Smith R, Adams JE, Nelson K, Silman AJ, et al. Radiographic features of lumbar disc degeneration and self-reported back pain. J Rheumatol 2004;31:753–8.
22. Fanuele JC, Abdu WA, Hanscom B, Weinstein JN. Association between obesity and functional status in patients with spine disease. Spine (Phila Pa 1976) 2002;27:306–12. [CrossRef]
23. Cvijetić S, McCloskey E, Korsić M. Vertebral osteophytosis and vertebral deformities in an elderly population sample. Wien Klin Wochenschr 2000;112:407–12.
24. Muraki S, Oka H, Akune T, Mabuchi A, En-Yo Y, Yoshida M, et al. Prevalence of radiographic lumbar spondylosis and its association with low back pain in elderly subjects of population-based cohorts: the ROAD study. Ann Rheum Dis 2009;68:1401–6. [CrossRef]