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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

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Abstract

The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40–80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4–L5; between multifidus at L4 and spondylolisthesis at L4–5; and between erector spinae at L4 and L5 with disc narrowing at L4–5 and L5–S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

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References

  1. Barker KL, Shamley DR, Jackson D (2004) Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine 29:E515–E519

    Article  PubMed  Google Scholar 

  2. Bolender NF, Schonstrom NS, Spengler DM (1985) Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am 67:240–246

    CAS  PubMed  Google Scholar 

  3. Bulcke JA, Termote JL, Palmers Y, Crolla D (1979) Computed tomography of the human skeletal muscular system. Neuroradiology 17:127–136

    CAS  PubMed  Google Scholar 

  4. Cooper RG, St Clair Forbes W, Jayson MI (1992) Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. Br J Rheumatol 31:389–394

    Article  CAS  PubMed  Google Scholar 

  5. Crisco JJ 3rd, Panjabi MM (1991) The intersegmental and multisegmental muscles of the lumbar spine. A biomechanical model comparing lateral stabilizing potential. Spine 16:793–799

    Article  PubMed  Google Scholar 

  6. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 9:266–272

    Article  CAS  PubMed  Google Scholar 

  7. Demoulin C, Crielaard JM, Vanderthommen M (2007) Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine 74:9–13

    Article  PubMed  Google Scholar 

  8. Dovrat E, Katz-Leurer M (2007) Cold exposure and low back pain in store workers in Israel. Am J Ind Med 50:626–631

    Article  PubMed  Google Scholar 

  9. Elliott JM, Jull GA, Noteboom JT, Durbridge GL, Gibbon WW (2007) Magnetic resonance imaging study of cross-sectional area of the cervical extensor musculature in an asymptomatic cohort. Clin Anat 20:35–40

    Article  CAS  PubMed  Google Scholar 

  10. Flicker PL, Fleckenstein JL, Ferry K, Payne J, Ward C, Mayer T, Parkey RW, Peshock RM (1993) Lumbar muscle usage in chronic low back pain. Magnetic resonance image evaluation. Spine 18:582–586

    Article  CAS  PubMed  Google Scholar 

  11. Ghaffari M, Alipour A, Jensen I, Farshad AA, Vingard E (2006) Low back pain among Iranian industrial workers. Occup Med (Lond) 56:455–460

    Article  Google Scholar 

  12. Gibbons LE, Latikka P, Videman T, Manninen H, Battie MC (1997) The association of trunk muscle cross-sectional area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men. J Spinal Disord 10:398–403

    Article  CAS  PubMed  Google Scholar 

  13. Grimby G, Saltin B (1983) The ageing muscle. Clin Physiol 3:209–218

    Article  CAS  PubMed  Google Scholar 

  14. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA (2005) Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 60:882–887

    PubMed  Google Scholar 

  15. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA (2005) Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain. J Gerontol A Biol Sci Med Sci 60:1420–1424

    PubMed  Google Scholar 

  16. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19:165–172

    Article  CAS  PubMed  Google Scholar 

  17. Hodges P, Holm AK, Hansson T, Holm S (2006) Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine 31:2926–2933

    Article  PubMed  Google Scholar 

  18. Hoffmann U, Siebert U, Bull-Stewart A, Achenbach S, Ferencik M, Moselewski F, Brady TJ, Massaro JM, O’Donnell CJ (2006) Evidence for lower variability of coronary artery calcium mineral mass measurements by multi-detector computed tomography in a community-based cohort-consequences for progression studies. Eur J Radiol 57:396–402

    Article  PubMed  Google Scholar 

  19. Hultman G, Nordin M, Saraste H, Ohlsen H (1993) Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. J Spinal Disord 6:114–123

    Article  CAS  PubMed  Google Scholar 

  20. Hyun JK, Lee JY, Lee SJ, Jeon JY (2007) Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy. Spine 32:E598–E602

    Article  PubMed  Google Scholar 

  21. Jinkins JR (2003) Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration. JBR-BTR 86:226–230

    PubMed  Google Scholar 

  22. Jones DA, Rutherford OM, Parker DF (1989) Physiological changes in skeletal muscle as a result of strength training. Q J Exp Physiol 74:233–256

    CAS  PubMed  Google Scholar 

  23. Kader DF, Wardlaw D, Smith FW (2000) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55:145–149

    Article  CAS  PubMed  Google Scholar 

  24. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (2009) Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J 9:545–550

    Article  PubMed  Google Scholar 

  25. Kalichman L, Hunter D (2007) Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum 37:69–80

    Article  PubMed  Google Scholar 

  26. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ (2009) Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976) 34:199–205

    Google Scholar 

  27. Kalichman L, Li L, Kim D, Guermazi A, Berkin V, O’Donnell C, Hoffmann U, Cole R, Hunter D (2008) Facet joint osteoarthritis and low back pain in the community-based population. Spine 33:2560–2565

    Article  PubMed  Google Scholar 

  28. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O (2004) Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine 29:3–8

    Article  PubMed  Google Scholar 

  29. Keller A, Gunderson R, Reikeras O, Brox JI (2003) Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine 28:1455–1460

    Article  PubMed  Google Scholar 

  30. Keller A, Johansen JG, Hellesnes J, Brox JI (1999) Predictors of isokinetic back muscle strength in patients with low back pain. Spine 24:275–280

    Article  CAS  PubMed  Google Scholar 

  31. Kelley DE, Slasky BS, Janosky J (1991) Skeletal muscle density: effects of obesity and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 54:509–515

    CAS  PubMed  Google Scholar 

  32. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C (2007) Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 5:2

    Article  PubMed  Google Scholar 

  33. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237

    Article  CAS  PubMed  Google Scholar 

  34. Laasonen EM (1984) Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology 26:9–13

    Article  CAS  PubMed  Google Scholar 

  35. Lexell J (1995) Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 50 Spec No:11–16

  36. Lexell J, Downham D (1992) What determines the muscle cross-sectional area? J Neurol Sci 111:113–114

    Article  CAS  PubMed  Google Scholar 

  37. MacDonald DA, Moseley GL, Hodges PW (2006) The lumbar multifidus: does the evidence support clinical beliefs? Man Ther 11:254–263

    Article  PubMed  Google Scholar 

  38. Macintosh JE, Bogduk N (1987) 1987 Volvo award in basic science. The morphology of the lumbar erector spinae. Spine 12:658–668

    Article  CAS  PubMed  Google Scholar 

  39. Mannion AF, Kaser L, Weber E, Rhyner A, Dvorak J, Muntener M (2000) 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 9:273–281

    Article  CAS  PubMed  Google Scholar 

  40. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, Smith S, Terry A (1989) Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14:33–36

    Article  CAS  PubMed  Google Scholar 

  41. McLoughlin RF, D’Arcy EM, Brittain MM, Fitzgerald O, Masterson JB (1994) The significance of fat and muscle areas in the lumbar paraspinal space: a CT study. J Comput Assist Tomogr 18:275–278

    Article  CAS  PubMed  Google Scholar 

  42. O’Sullivan PB, Phyty GD, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:2959–2967

    Article  PubMed  Google Scholar 

  43. Panjabi MM (2006) A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J 15:668–676

    Article  PubMed  Google Scholar 

  44. Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5:383–389 (Discussion 397)

    Article  CAS  PubMed  Google Scholar 

  45. Parikh NI, Hwang SJ, Larson MG, Cupples LA, Fox CS, Manders ES, Murabito JM, Massaro JM, Hoffmann U, O’Donnell CJ (2007) Parental occurrence of premature cardiovascular disease predicts increased coronary artery and abdominal aortic calcification in the Framingham Offspring and Third Generation cohorts. Circulation 116:1473–1481

    Article  PubMed  Google Scholar 

  46. Parkkola R, Kormano M (1992) Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. J Spinal Disord 5:86–92

    Article  CAS  PubMed  Google Scholar 

  47. Parkkola R, Rytokoski U, Kormano M (1993) Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 18:830–836

    Article  CAS  PubMed  Google Scholar 

  48. Peltonen JE, Taimela S, Erkintalo M, Salminen JJ, Oksanen A, Kujala UM (1998) 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 77:66–71

    Article  CAS  PubMed  Google Scholar 

  49. Savage RA, Whitehouse GH, Roberts N (1997) The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J 6:106–114

    Article  CAS  PubMed  Google Scholar 

  50. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581

    Article  CAS  PubMed  Google Scholar 

  51. Sortland O, Magnaes B, Hauge T (1977) Functional myelography with metrizamide in the diagnosis of lumbar spinal stenosis. Acta Radiol Suppl 355:42–54

    CAS  PubMed  Google Scholar 

  52. Storheim K, Holm I, Gunderson R, Brox JI, Bo K (2003) The effect of comprehensive group training on cross-sectional area, density, and strength of paraspinal muscles in patients sick-listed for subacute low back pain. J Spinal Disord Tech 16:271–279

    PubMed  Google Scholar 

  53. Termote JL, Baert A, Crolla D, Palmers Y, Bulcke JA (1980) Computed tomography of the normal and pathologic muscular system. Radiology 137:439–444

    CAS  PubMed  Google Scholar 

  54. Verbiest H (1979) The significance and principles of computerized axial tomography in idiopathic developmental stenosis of the bony lumbar vertebral canal. Spine 4:369–378

    Article  CAS  PubMed  Google Scholar 

  55. Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J (2003) Associations between back pain history and lumbar MRI findings. Spine 28:582–588

    Article  PubMed  Google Scholar 

  56. Videman T, Battie MC, Ripatti S, Gill K, Manninen H, Kaprio J (2006) Determinants of the progression in lumbar degeneration: a 5-year follow-up study of adult male monozygotic twins. Spine 31:671–678

    Article  PubMed  Google Scholar 

  57. Waddell G (1996) Low back pain: a twentieth century health care enigma. Spine 21:2820–2825

    Article  CAS  PubMed  Google Scholar 

  58. Weishaupt D, Zanetti M, Boos N, Hodler J (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 28:215–219

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the National Heart, Lung and Blood Institute’s Framingham Heart Study contract (No. N01-HC-25195) for the recruitment, enrollment, and examination of the Offspring and Third Generation Cohort and the imaging by computed tomography scan.

Conflict of interest statement

None of the authors have any conflict of interest regarding the contents of this article. L. K. is supported by an Arthritis Foundation Postdoctoral Grant. P. H. is supported by a Research Fellowship from the National Health and Medical Research Council of Australia.

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Authors and Affiliations

  1. Boston University School of Medicine, Boston, USA

    Leonid Kalichman & David J. Hunter

  2. Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA, 02120, USA

    Leonid Kalichman, Ling Li & David J. Hunter

  3. Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

    Paul Hodges

  4. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Ali Guermazi

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  1. Leonid Kalichman
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Correspondence to Leonid Kalichman.

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Kalichman, L., Hodges, P., Li, L. et al. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 19, 1136–1144 (2010). https://doi.org/10.1007/s00586-009-1257-5

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  • DOI: https://doi.org/10.1007/s00586-009-1257-5

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