Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation

Dong Sun, Peng Liu, Jie Cheng, Zikun Ma, Jingpei Liu, Tingzheng Qin, Dong Sun, Peng Liu, Jie Cheng, Zikun Ma, Jingpei Liu, Tingzheng Qin

Abstract

Background: To assess the correlation between lumbar disc degeneration (LDD), multifidus muscle atrophy (LMA), and facet joints degeneration in patients with L4-L5 lumbar disc herniation (LDH).

Methods: Sixty patients with L4-L5 LDH diagnosed by a 1.5 T MRI scanner were enrolled in the study group and another 60 patients with non-specific back pain were enrolled in the control group. LDD, LMA, and facet joints degeneration were examined and analyzed independently by two independent orthopedic surgeons using T2-weighted images. Wilcoxon test was used for analyzing the difference of LDD and facet joints degeneration between L3-L4 and L5-S1 and difference of LMA between the herniated and control groups. Correlation analysis of the three degeneration grades at the same level was determined by Spearman rank correlation test.

Results: In the herniated group, most LMA at L3-L4 level was grade 1 (42, 70.0%); grade 2 (33, 55.0%) at L4-L5 level; and grade 3 (27, 45.0%) at L5-S1 level. LMA and LDD grading were significantly different between L3-L4 and L5-S1 levels (P < 0.05). In the herniation group, the Spearman value for LDD and LMA grading were 0.352 (P < 0.01) at L3-L4 and 0.036 (P > 0.05) at the L5-S1 level. The differences in LMA between the herniated and control groups at the three levels were significant (P < 0.05).

Conclusions: Disc degeneration and multifidus muscles atrophy were positively correlated at the L3-L4 disc level. A lumbar extension muscle strengthening program could be helpful in preventing muscle atrophy and lumbar spinal degeneration.

Keywords: Disc degeneration; Facet joints degeneration; Lumbar disc herniation; Lumbar extension muscle strengthening program; Multifidus muscle atrophy.

Figures

Fig. 1
Fig. 1
Goutallier grading (range, 0 to 4) on T1W axial MRIs are represented by (a) to (e), respectively [9, 12], and are graded as: grade 0, normal muscle tissue; grade 1, fat streaks; grade 2, more muscle than fat; grade 3, equal amounts of fat and muscle tissue; and grade 4, more fat than muscle
Fig. 2
Fig. 2
Examples of MRIs on T2W axial with Pathria grades 0 to 3 are shown [14]. Four grades of osteoarthritis of the facet joints were defined as: (a) grade 0, normal; (b) grade 1, mild degenerative disease; grade 2, moderate degenerative disease; and (c) grade 3, severe degenerative disease
Fig. 3
Fig. 3
Lumbar multifidus atrophy, lumbar disc, and facet joints degeneration in the herniated and control groups. a lumbar disc degeneration in the herniated group; b lumbar multifidus atrophy in the herniated group; c lumbar multifidus atrophy in the control group; d facet joint degeneration in the herniated group
Fig. 4
Fig. 4
Distribution of multifidus atrophy in the herniated and control groups. 0: grade 0 of multifidus; 1: grade 1 of multifidus; 2: grade 2 of multifidus; 3: grade 3 of multifidus; 4: grade 4 of multifidus

References

    1. Porter RW. Management of back pain. London: Churchill Livingstone; 1986. pp. 89–103.
    1. Bogduk N, Wilson AS, Tynan W. The human lumbar dorsal rami. J Anat. 1982;134(Pt 2):383–97.
    1. Macintosh JE, Valencia F, Bogduk N, Munro RR. The morphology of the human lumbar multifidus. Clin Biomech (Bristol, Avon) 1986;1(4):196–204. doi: 10.1016/0268-0033(86)90146-4.
    1. Macintosh JE, Bogduk N. The biomechanics of the lumbar multifidus. Clin Biomech (Bristol, Avon) 1986;1(4):205–13. doi: 10.1016/0268-0033(86)90147-6.
    1. Zhao WP, Kawaguchi Y, Matsui H, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine (Phila Pa 1976) 2000;25(17):2191–9. doi: 10.1097/00007632-200009010-00009.
    1. Yoshihara K, Shirai Y, Nakayama Y, Uesaka S. Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 2001;26(6):622–6. doi: 10.1097/00007632-200103150-00012.
    1. Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2(2):142–6. doi: 10.1016/j.pmrj.2009.11.006.
    1. Lee JC, Cha JG, Kim Y, Kim YI, Shin BJ. Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine (Phila Pa 1976) 2008;33(3):318–25. doi: 10.1097/BRS.0b013e318162458f.
    1. Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, Hodler J. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786–92. doi: 10.1148/radiol.2403050820.
    1. Tabaraee E, Ahn J, Bohl DD, Phillips FM, Singh K. Quantification of multifidus atrophy and fatty infiltration following a minimally invasive microdiscectomy. Int J Spine Surg. 2015;9:25. doi: 10.14444/2025.
    1. Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H, Yamano Y. New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine (Phila Pa 1976) 2016;41(2):E84–90. doi: 10.1097/BRS.0000000000001154.
    1. Battaglia PJ, Maeda Y, Welk A, Hough B, Kettner N. Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manipulative Physiol Ther. 2014;37(3):190–7. doi: 10.1016/j.jmpt.2013.12.010.
    1. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2007;32(24):E708–12. doi: 10.1097/BRS.0b013e31815a59a0.
    1. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology. 1987;164(1):227–30. doi: 10.1148/radiology.164.1.3588910.
    1. Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976) 2006;31(25):2926–33. doi: 10.1097/01.brs.0000248453.51165.0b.
    1. Bogduk N. Clinical anatomy of lumbar Spine and Sacrum. 3. Edinburgh: Churchill Livingston; 1997.
    1. Bakou S, Cherel Y, Gabinaud B, Guigand L, Wyers M. Type-specific changes in fibre size and satellite cell activation following muscle denervation in two strains of turkey (Meleagris gallopavo) J Anat. 1996;188(Pt 3):677–91.
    1. Bishop DL, Milton RL. The effects of denervation location on fiber type mix in self-reinnervated mouse soleus muscles. Exp Neurol. 1997;147(1):151–8. doi: 10.1006/exnr.1997.6605.
    1. Okada Y. Histochemical study on the atrophy of the quadriceps femoris muscle caused by knee joint injuries of rats. Hiroshima J Med Sci. 1989;38(1):13–21.
    1. Herbison GJ, Jaweed MM, Ditunno JF. Muscle atrophy in rats following denervation, casting, inflammation, and tenotomy. Arch Phys Med Rehabil. 1979;60(9):401–4.
    1. Weber BR, Grob D, Dvorak J, Muntener M. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine (Phila Pa 1976) 1997;22(15):1765–72. doi: 10.1097/00007632-199708010-00017.
    1. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9. doi: 10.1053/crad.1999.0340.
    1. Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2–10. doi: 10.1054/math.1995.0243.
    1. Oosterhuis T, Costa LO, Maher CG, de Vet HC, van Tulder MW, Ostelo RW. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. 2014;3:Cd003007.
    1. McGregor AH, Probyn K, Cro S, Dore CJ, Burton AK, Balague F, Pincus T, Fairbank J. Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database Syst Rev. 2013;12:Cd009644.
    1. Min SH, Kim MH, Seo JB, Lee JY, Lee DH. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J. 2009;3(2):89–95. doi: 10.4184/asj.2009.3.2.89.
    1. Bresnahan LE, Smith JS, Ogden AT, Quinn S, Cybulski GR, Simonian N, Natarajan RN, Fessler RD, Fessler RG. Assessment of paraspinal muscle cross-sectional area following lumbar decompression: minimally invasive versus open approaches. J Spinal Disord Tech. 2013;1536–0652.
    1. Pourtaheri S, Issa K, Lord E, Ajiboye R, Drysch A, Hwang K, Faloon M, Sinha K, Emami A. Paraspinal muscle atrophy after lumbar spine surgery. Orthopedics. 2016;39(2):e209–e214.
    1. Putzier M, Hartwig T, Hoff EK, Streitparth F, Strube P. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF – a prospective randomized clinical trial. Spine J. 2016;16:811–9.
    1. Choi G, Raiturker PP, Kim MJ, Chung DJ, Chae YS, Lee SH. The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery. 2005;57(4):764–72. doi: 10.1093/neurosurgery/57.4.764.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться