paraspinal muscles
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PURPOSE: The pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood. To date, potentially involved local changes in the deep paraspinal muscles still remain unknown. METHODS: Needle electromyography (EMG) and muscle biopsy of paraspinal muscles at convexity and concavity of the AIS main thoracic curve were performed in 25 subjects. In this group, EMG was performed in 16 AIS subjects (12 females, 12-27 years), muscle biopsy in 18 AIS subjects (15 females, 11-31 years) compared to 10 non-scoliotic controls (6 females, 12-55 years). Samples of muscle tissue were removed during corrective surgery and were examined histologically, enzyme histochemically and immunohistochemically. Both methods of EMG and muscle biopsy were performed in 9 subjects (7 women, 12-27 years). RESULTS: Right curve convexity was found in 24 AIS subjects. Amplitudes of motor unit action potentials (MUPs) were significantly increased on the AIS curve convexity versus concavity. Turns, duration and phases of MUPs were without any significant changes. In all 18 subjects, the histological examination revealed muscle fiber redistribution with numerical predominance of type I on the curve convexity which strongly correlated with the progression of the Cobb angle. CONCLUSION: Our findings demonstrate significant changes of muscle fiber redistribution in the paraspinal muscles of AIS with increased proportion of type I on the convexity corresponding to a significantly higher amplitude of MUPs on the same side. A possible explanation of this alteration is a secondary adaptation due to chronic high load demand.
- MeSH
- dítě MeSH
- dospělí MeSH
- elektromyografie MeSH
- hluboké zádové svaly * patologie patofyziologie MeSH
- kosterní svalová vlákna patologie fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- progrese nemoci MeSH
- skolióza * patologie patofyziologie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Bolesti dolní části zad (low back pain; LBP) jsou mimořádně častým a závažným zdravotním problémem. Paraspinální svaly hrají důležitou funkci při pohybech trupu, přispívají k udržení postury a stability páteře. U pacientů s chronickými LBP dochází ke strukturálním i funkčním změnám paraspinálních svalů. Makroskopické změny lze vyšetřit na CT a zejména na MR, mikroskopické změny pomocí svalové biopsie. V dostupné literatuře existují důkazy, že atrofie paraspinálních svalů a zvýšení podílu tukové tkáně uvnitř paraspinálních svalů jsou významně asociovány s nespecifickými LBP, a to zejména s chronickými bolestmi. Z diferenciálně diagnostického hlediska je nutné změny v paraspinálních svalech asociované s LBP odlišit od postižení paraspinálních svalů u pacientů s axiálními myopatiemi, které jsou však vzácné. Cílem tohoto sdělení je upozornit na strukturální i funkční změny paraspinálních svalů u pacientů s chronickými nespecifickými LBP. Je uveden diagnostický postup při chronických LBP spojených s degenerací paraspinálních svalů k vyloučení přítomnosti axiální myopatie.
Low back pain (LBP) is a frequent and major health problem. Paraspinal muscles play an important role in trunk movements, helping to maintain posture and spinal stability. Changes of paraspinal muscle morphology and function are described in patients with chronic LBP. Macroscopic changes can be evaluated by CT and especially by MRI, while microscopic changes are assed by muscle biopsy. There is evidence available in literature stating that atrophy of paraspinal muscles and increased fat deposits in the paraspinal muscles are significantly associated with non-specific LBP, especially with chronic LBP. From a ferential diagnostic point of view, changes in paraspinal muscles associated with LBP must be distinguished from paraspinal muscle involvement in patients with axial myopathies, but these are rare. The aim of this paper is to highlight the structural and functional changes of paraspinal muscles in patients with chronic non-specific LBP. A diagnostic algorithm for chronic LBP associated with degeneration of paraspinal muscles to exclude the presence of axial myopathy is presented.
- Klíčová slova
- axiální myopatie, tuková infiltrace,
- MeSH
- hluboké zádové svaly * diagnostické zobrazování patologie MeSH
- lidé MeSH
- lumbalgie * komplikace patologie MeSH
- magnetická rezonanční tomografie metody MeSH
- nemoci svalů diagnóza patologie rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Muscle ageing involves structural and functional changes of muscles, mainly their replacement by fatty and fibrous tissue accompanied by the loss of muscle function. Quantitative magnetic resonance imaging (qMRI) methods have potential to provide biomarkers of degenerative changes in muscles with ageing. To assess the relationship between qMRI parameters of lumbar paraspinal muscles (LPMs) and their function and evolution with ageing in healthy subjects, 90 volunteers underwent MRI of lumbar spine and LPM utilising a 6-point Dixon gradient echo sequence. Using manual muscle segmentation, fat fraction (FF) and functional muscle volume (FMV) were calculated for LPM, with the psoas muscle (PS) as a control muscle. Functional parameters of LPM (strength and endurance) were assessed. Based on our data analysis, both FF and FMV of LPM correlate significantly with maximal isometric lumbar extensor muscle strength, but not with endurance. With ageing, FF of LPM increases by 34% per decade, while FF of PS increases by 17% per decade. This difference between LPM and the PS in the rate of FF increase is significant. FMV evinces a decreasing trend in both LPM and PS. However, only FMV of PS decreases significantly by 7% per decade. Our cross-sectional study shows a significant correlation between qMRI parameters of LPM and their strength. FF appears to be a biomarker of muscle ageing with different ageing patterns of distinct muscle groups: LPM and PS.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Lumbar paraspinal muscles (LPM), which belong to lumbar extensor muscles, play a key role in stabilising the lumbar spine and maintaining spine health. Although chronic non-specific low back pain (CNLBP) represents a major health problem worldwide, there is a knowledge gap regarding the function, morphology of LPM, and the effect of regular exercise on them in patients with CNLBP. The purpose of the study was to evaluate functional and quantitative MRI (qMRI) parameters of LPM in CNLBP patients, compare them to matched healthy volunteers (HV), and assess the effect of exercise therapy on these parameters in CNLBP patients. METHODS: The first part of the study was cross-sectional, observational, and comparative; the second was prospective and interventional. Based on physiological parameters, 43 matched pairs of CNLBP patients and HV were formed. All participants underwent MRI of the LPM using a 6-point Dixon gradient-echo sequence to assess qMRI parameters: fat fraction, total muscle volume, and functional muscle volume (FMV). Maximal isometric lumbar extensor muscle strength (MILEMS), lumbar extensor muscle endurance (LEME), MILEMS to LPM FMV ratio, pain, and disability were assessed. Each group's parameters were compared and effect size evaluated. The total of 29 patients entered an 18-week hybrid guided daily home-based exercise programme, which was completed by 27 CNLBP patients. The study was registered, trial registration number is ISRCTN11556477. RESULTS: CNLBP patients had significantly lower MILEMS, LEME (both P < 0.001), and MILEMS to LPM FMV ratio (P = 0.006) compared to matched HV. These parameters, as well as pain and disability, improved significantly after exercise (each P < 0.001). The qMRI parameters did not differ between CNLBP patients and HV, nor did they change after exercise therapy. CONCLUSIONS: The significant LPM dysfunction and poorer muscle quality in CNLBP patients were reversible with exercise. Our study does not support the use of qMRI parameters as objective and reliable biomarkers of LPM dysfunction in a cohort of CNLBP with mild clinical impairment.
- Publikační typ
- časopisecké články MeSH
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.
- MeSH
- bederní obratle * chirurgie diagnostické zobrazování MeSH
- fúze páteře * metody MeSH
- hluboké zádové svaly * diagnostické zobrazování patologie MeSH
- kortikální kost chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- pedikulární šrouby MeSH
- pooperační komplikace diagnostické zobrazování MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spondylolistéza * chirurgie diagnostické zobrazování MeSH
- svalová atrofie * etiologie diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The pathogenesis of adolescent idiopathic scoliosis (AIS), including the associated local changes in deep paravertebral muscles, is poorly understood. The asymmetric expression of several molecules involved in the melatonin signaling pathway, including melatonin receptors 1A/1B (MTNR1A/MTNR1B), estrogen receptor 2 (ESR2) and calmodulin (CALM1), has previously been suggested to be associated with AIS. However, this hypothesis is based on single studies in which the data were obtained by different methodological approaches. Therefore, to evaluate the symmetry of the mRNA expression levels of these molecules, 18 patients with AIS and 10 non‑scoliotic controls were enrolled in the present study. Muscle biopsy samples from deep paraspinal muscles (from the convexity and concavity of the scoliotic curve in patients with AIS, or from the left and right sides in controls) were obtained during spinal surgery. For each sample, the relative mRNA expression levels of MTNR1A, MTNR1B, CALM1 and ESR2 were analyzed by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and were quantified according to the quantification cycle method. The results indicated that the mRNA expression levels of none of the investigated molecules were significantly different between samples obtained from the convex and concave side of the scoliotic curve in patients with AIS. In addition, no difference in expression was detected between the patients with AIS and the controls. With regards to MTNR1A and MTNR1B, their expression was very weak in paravertebral muscles, and in the majority of cases their expression could not be detected by repeated RT‑qPCR analysis. Therefore, these data do not support the previously suggested role of the asymmetric expression of molecules involved in the melatonin signaling pathway in deep paravertebral muscles in the pathogenesis of AIS.
- MeSH
- beta receptor estrogenů genetika MeSH
- dítě MeSH
- dospělí MeSH
- exprese genu MeSH
- genetická predispozice k nemoci MeSH
- hluboké zádové svaly metabolismus MeSH
- kalmodulin genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- messenger RNA MeSH
- mladiství MeSH
- mladý dospělý MeSH
- receptor melatoninový MT1 genetika MeSH
- receptor melatoninový MT2 genetika MeSH
- skolióza etiologie metabolismus patologie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
