Progress on the evaluation method of paraspinal muscle and its correlation with lumbar diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Wei ^1,2 ,  LI Weishi ¹ , CHEN Zhongqiang ¹

1. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P.R.China;
2. Peking University Health Science Center, Beijing, 100191, P.R.China;

Corresponding?author：

LI Weishi, Email: puh3liweishi@163.com

Keywords：

Atrophy of paraspinal muscle; lumbar spine disease; measurement

DOI：

10.7507/1002-1892.201912120

Video：

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Objective To review the evaluation method of paraspinal muscle and its role in lumbar spine diseases, and offer reference for further research on paraspinal muscles.Methods The related literature of paraspinal muscle measurement and its role in lumbar spine diseases was reviewed. The evaluation methods of paraspinal muscle were analyzed from the advantages and disadvantages and the role of paraspinal muscle in lumbar spine diseases was summarized.Results Radiographic methods are often used to evaluate the atrophy of paraspinal muscle, mainly including CT and MRI. The cross-sectional area and fatty infiltration of paraspinal muscle are two key parameters. Radiographic methods are reproducible and widely applied, but CT has the disadvantage of radiation exposure, while the cost of MRI is high. Besides, more and more researchers focus on the functional evaluation of paraspinal muscle, which mainly includes surface electromyogram analysis and back muscle strength test. The surface electromyogram analysis can quantitatively measure neuromuscular function, but the results could be affected by many influencing factors. The back muscle strength test is simple, but it lacks standardized posture. The atrophy of paraspinal muscle is related to many lumbar spine diseases, while the results of different researches are different.Conclusion There are many methods to evaluate paraspinal muscles, but there is no unified standard. The role of paraspinal muscle in lumbar spine diseases need to be further studied.

Citation： WANG Wei, LI Weishi, CHEN Zhongqiang. Progress on the evaluation method of paraspinal muscle and its correlation with lumbar diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1462-1467. doi: 10.7507/1002-1892.201912120 Copy

1.	Sun D, Liu P, Cheng J, et al. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation. BMC Musculoskelet Disord, 2017, 18(1): 167.
2.	Shafaq N, Suzuki A, Matsumura A, et al. Asymmetric degeneration of paravertebral muscles in patients with degenerative lumbar scoliosis. Spine (Phila Pa 1976), 2012, 37(16): 1398-1406.
3.	Zotti MGT, Boas FV, Clifton T, et al. Does pre-operative magnetic resonance imaging of the lumbar multifidus muscle predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis? Eur Spine J, 2017, 26(10): 2589-2597.
4.	Hyun SJ, Kim YJ, Rhim SC. Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J, 2016, 16(9): 1095-1101.
5.	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, 2010, 19(7): 1136-1144.
6.	Shahidi B, Parra CL, Berry DB, et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976), 2017, 42(8): 616-623.
7.	Yagi M, Hosogane N, Watanabe K, et al. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J, 2016, 16(4): 451-458.
8.	Urrutia J, Besa P, Lobos D, et al. Is a single-level measurement of paraspinal muscle fat infiltration and cross-sectional area representative of the entire lumbar spine? Skeletal Radiol, 2018, 47(7): 939-945.
9.	袁磊, 陳蕭霖, 曾巖, 等. 退變性腰椎側凸患者椎旁肌退變與術后近端交界性后凸的相關性研究. 中國脊柱脊髓雜志, 2018, 28(5): 425-433.
10.	Lu WW, Hu Y, Luk KD, et al. Paraspinal muscle activities of patients with scoliosis after spine fusion: an electromyographic study. Spine (Phila Pa 1976), 2002, 27(11): 1180-1185.
11.	Biering-S?rensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine (Phila Pa 1976), 1984, 9(2): 106-119.
12.	Hu ZJ, He J, Zhao FD, et al. An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976), 2011, 36(13): E868-E874.
13.	Keller A, Gunderson R, Reiker?s O, et al. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976), 2003, 28(13): 1455-1460.
14.	Sinelnikov A, Qu C, Fetzer DT, et al. Measurement of skeletal muscle area: Comparison of CT and MR imaging. Eur J Radiol, 2016, 85(10): 1716-1721.
15.	Hebert JJ, Koppenhaver SL, Parent EC, et al. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine (Phila Pa 1976), 2009, 34(23): E848-E856.
16.	Ogon I, Takebayashi T, Takashima H, et al. Magnetic resonance spectroscopic analysis of multifidus muscles lipid content and association with spinopelvic malalignment in chronic low back pain. Br J Radiol, 2017, 90(1073): 20160753.
17.	Takashima H, Takebayashi T, Ogon I, et al. Evaluation of intramyocellular and extramyocellular lipids in the paraspinal muscle in patients with chronic low back pain using MR spectroscopy: preliminary results. Br J Radiol, 2016, 89(1064): 20160136.
18.	Fischer MA, Nanz D, Shimakawa A, et al. Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology, 2013, 266(2): 555-563.
19.	Berry DB, Padwal J, Johnson S, et al. Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine. BMC Musculoskelet Disord, 2018, 19(1): 135.
20.	Boissière L, Moal B, Gille O, et al. Lumbar spinal muscles and spinal canal study by MRI three-dimensional reconstruction in adult lumbar spinal stenosis. Orthop Traumatol Surg Res, 2017, 103(2): 279-283.
21.	Ranson CA, Burnett AF, Kerslake R, et al. An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J, 2006, 15(6): 764-773.
22.	Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol, 2000, 55(2): 145-149.
23.	Parkkola R, Ryt?koski 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(7): 830-836.
24.	Kjaer P, Bendix T, Sorensen JS, et al. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med, 2007, 5: 2.
25.	Yanik B, Keyik B, Conkbayir I. Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging. Skeletal Radiol, 2013, 42(6): 771-778.
26.	Mengiardi B, Schmid MR, Boos N, 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(3): 786-792.
27.	Larivière C, Bilodeau M, Forget R, et al. Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976), 2010, 35(22): E1178-E1186.
28.	李永忠, 陳文君, 戴潔, 等. 基于表面肌電信號分析的退行性腰椎后凸患者手術前、后椎旁肌肉功能變化研究. 中華物理醫學與康復雜志, 2018, 40(4): 290-295.
29.	李建華. 表面肌電圖的康復臨床評估應用進展. 實用醫院臨床雜志, 2014, 11(5): 4-6.
30.	潘文平, 范建中. 表面肌電圖在康復醫學中的一些應用. 中國康復, 2011, 26(1): 59-60.
31.	Hansen JW. Postoperative management in lumbar disc protrusions. Ⅰ. Indications, method and results. Ⅱ. Follow-up on a trained and an untrained group of patients. Acta Orthop Scand Suppl, 1964, Suppl 71: 1-47.
32.	Ito T, Shirado O, Suzuki H, et al. Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil, 1996, 77(1): 75-79.
33.	Simson KJ, Miller CT, Ford J, et al. Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial. Trials, 2017, 18(1): 184.
34.	張昊聰, 王兆瀚, 張子方, 等. 術前脊柱后方肌群肌力對長節段固定融合糾正退行性脊柱側凸矢狀位失衡的影響. 中國脊柱脊髓雜志, 2017, 27(6): 517-523.
35.	María Pilar García-Vaquero, David Barbado, Casto Juan-Recio, et al. Isokinetic trunk flexion-extension protocol to assess trunk muscle strength and endurance: reliability, learning effect and sex differences. Journal of Sport and Health Science, 2016. doi: 10.1016/j.jshs.2016.08.011.
36.	宣磊, 吳建賢, 潘家武. 等速技術在康復醫學領域中的研究進展. 中國康復理論與實踐, 2019, 25(7): 788-792.
37.	宋愛晶, 鄧京捷, 呂曉紅, 等. 等速肌力測試膝、踝關節及腰背肌力量的評價. 中國組織工程研究, 2015, 10(46): 7425-7429.
38.	黃婷婷, 范利華, 高東, 等. 等速肌力測試與訓練技術在肌肉功能評定中的研究進展. 法醫學雜志, 2013, 29(1): 49-52.
39.	Wan Q, Lin C, Li X, et al. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol, 2015, 88(1053): 20140546.
40.	Danneels LA, Vanderstraeten GG, Cambier DC, et al. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J, 2000, 9(4): 266-272.
41.	Masaki M, Aoyama T, Murakami T, et al. Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers. Clin Biomech (Bristol, Avon), 2017, 49: 128-133.
42.	Ranger TA, Cicuttini FM, Jensen TS, et al. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J, 2017, 17(11): 1729-1748.
43.	Lee JH, Lee SH. Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black? Indian J Orthop, 2017, 51(2): 147-154.
44.	劉斌, 劉向陽, 王國平, 等. 腰椎骨質疏松性骨折患者椎旁肌肉 MRI 指標測量及臨床意義. 中國組織工程研究, 2019, 23(4): 578-583.
45.	Jun HS, Kim JH, Ahn JH, et al. The effect of lumbar spinal muscle on spinal sagittal alignment: evaluating muscle quantity and quality. Neurosurgery, 2016, 79(6): 847-855.
46.	Hiyama A, Katoh H, Sakai D, et al. The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis. BMC Musculoskelet Disord, 2019, 20(1): 352.
47.	Banno T, Arima H, Hasegawa T, et al. The effect of paravertebral muscle on the maintenance of upright posture in patients with adult spinal deformity. Spine Deform, 2019, 7(1): 125-131.
48.	王雪鵬, 王圣杰, 晏鵬, 等. 椎旁肌肉損傷對腰椎椎體骨質量的影響. 中華醫學雜志, 2016, 96(43): 3515-3518.
49.	Strube P, Putzier M, Streitparth F, et al. Postoperative posterior lumbar muscle changes and their relationship to segmental motion preservation or restriction: a randomized prospective study. J Neurosurg Spine, 2016, 24(1): 25-31.
50.	Tandon R, Kiyawat V, Kumar N. Clinical correlation between muscle damage and Oswestry Disability Index Score after open lumbar surgery: Does open surgery reduces functional ability? Asian Spine J, 2018, 12(3): 518-523.

1. Sun D, Liu P, Cheng J, et al. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation. BMC Musculoskelet Disord, 2017, 18(1): 167.
2. Shafaq N, Suzuki A, Matsumura A, et al. Asymmetric degeneration of paravertebral muscles in patients with degenerative lumbar scoliosis. Spine (Phila Pa 1976), 2012, 37(16): 1398-1406.
3. Zotti MGT, Boas FV, Clifton T, et al. Does pre-operative magnetic resonance imaging of the lumbar multifidus muscle predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis? Eur Spine J, 2017, 26(10): 2589-2597.
4. Hyun SJ, Kim YJ, Rhim SC. Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J, 2016, 16(9): 1095-1101.
5. 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, 2010, 19(7): 1136-1144.
6. Shahidi B, Parra CL, Berry DB, et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976), 2017, 42(8): 616-623.
7. Yagi M, Hosogane N, Watanabe K, et al. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J, 2016, 16(4): 451-458.
8. Urrutia J, Besa P, Lobos D, et al. Is a single-level measurement of paraspinal muscle fat infiltration and cross-sectional area representative of the entire lumbar spine? Skeletal Radiol, 2018, 47(7): 939-945.
9. 袁磊, 陳蕭霖, 曾巖, 等. 退變性腰椎側凸患者椎旁肌退變與術后近端交界性后凸的相關性研究. 中國脊柱脊髓雜志, 2018, 28(5): 425-433.
10. Lu WW, Hu Y, Luk KD, et al. Paraspinal muscle activities of patients with scoliosis after spine fusion: an electromyographic study. Spine (Phila Pa 1976), 2002, 27(11): 1180-1185.
11. Biering-S?rensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine (Phila Pa 1976), 1984, 9(2): 106-119.
12. Hu ZJ, He J, Zhao FD, et al. An assessment of the intra- and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine (Phila Pa 1976), 2011, 36(13): E868-E874.
13. Keller A, Gunderson R, Reiker?s O, et al. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976), 2003, 28(13): 1455-1460.
14. Sinelnikov A, Qu C, Fetzer DT, et al. Measurement of skeletal muscle area: Comparison of CT and MR imaging. Eur J Radiol, 2016, 85(10): 1716-1721.
15. Hebert JJ, Koppenhaver SL, Parent EC, et al. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine (Phila Pa 1976), 2009, 34(23): E848-E856.
16. Ogon I, Takebayashi T, Takashima H, et al. Magnetic resonance spectroscopic analysis of multifidus muscles lipid content and association with spinopelvic malalignment in chronic low back pain. Br J Radiol, 2017, 90(1073): 20160753.
17. Takashima H, Takebayashi T, Ogon I, et al. Evaluation of intramyocellular and extramyocellular lipids in the paraspinal muscle in patients with chronic low back pain using MR spectroscopy: preliminary results. Br J Radiol, 2016, 89(1064): 20160136.
18. Fischer MA, Nanz D, Shimakawa A, et al. Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology, 2013, 266(2): 555-563.
19. Berry DB, Padwal J, Johnson S, et al. Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine. BMC Musculoskelet Disord, 2018, 19(1): 135.
20. Boissière L, Moal B, Gille O, et al. Lumbar spinal muscles and spinal canal study by MRI three-dimensional reconstruction in adult lumbar spinal stenosis. Orthop Traumatol Surg Res, 2017, 103(2): 279-283.
21. Ranson CA, Burnett AF, Kerslake R, et al. An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J, 2006, 15(6): 764-773.
22. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol, 2000, 55(2): 145-149.
23. Parkkola R, Ryt?koski 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(7): 830-836.
24. Kjaer P, Bendix T, Sorensen JS, et al. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med, 2007, 5: 2.
25. Yanik B, Keyik B, Conkbayir I. Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging. Skeletal Radiol, 2013, 42(6): 771-778.
26. Mengiardi B, Schmid MR, Boos N, 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(3): 786-792.
27. Larivière C, Bilodeau M, Forget R, et al. Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976), 2010, 35(22): E1178-E1186.
28. 李永忠, 陳文君, 戴潔, 等. 基于表面肌電信號分析的退行性腰椎后凸患者手術前、后椎旁肌肉功能變化研究. 中華物理醫學與康復雜志, 2018, 40(4): 290-295.
29. 李建華. 表面肌電圖的康復臨床評估應用進展. 實用醫院臨床雜志, 2014, 11(5): 4-6.
30. 潘文平, 范建中. 表面肌電圖在康復醫學中的一些應用. 中國康復, 2011, 26(1): 59-60.
31. Hansen JW. Postoperative management in lumbar disc protrusions. Ⅰ. Indications, method and results. Ⅱ. Follow-up on a trained and an untrained group of patients. Acta Orthop Scand Suppl, 1964, Suppl 71: 1-47.
32. Ito T, Shirado O, Suzuki H, et al. Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil, 1996, 77(1): 75-79.
33. Simson KJ, Miller CT, Ford J, et al. Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial. Trials, 2017, 18(1): 184.
34. 張昊聰, 王兆瀚, 張子方, 等. 術前脊柱后方肌群肌力對長節段固定融合糾正退行性脊柱側凸矢狀位失衡的影響. 中國脊柱脊髓雜志, 2017, 27(6): 517-523.
35. María Pilar García-Vaquero, David Barbado, Casto Juan-Recio, et al. Isokinetic trunk flexion-extension protocol to assess trunk muscle strength and endurance: reliability, learning effect and sex differences. Journal of Sport and Health Science, 2016. doi: 10.1016/j.jshs.2016.08.011.
36. 宣磊, 吳建賢, 潘家武. 等速技術在康復醫學領域中的研究進展. 中國康復理論與實踐, 2019, 25(7): 788-792.
37. 宋愛晶, 鄧京捷, 呂曉紅, 等. 等速肌力測試膝、踝關節及腰背肌力量的評價. 中國組織工程研究, 2015, 10(46): 7425-7429.
38. 黃婷婷, 范利華, 高東, 等. 等速肌力測試與訓練技術在肌肉功能評定中的研究進展. 法醫學雜志, 2013, 29(1): 49-52.
39. Wan Q, Lin C, Li X, et al. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol, 2015, 88(1053): 20140546.
40. Danneels LA, Vanderstraeten GG, Cambier DC, et al. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J, 2000, 9(4): 266-272.
41. Masaki M, Aoyama T, Murakami T, et al. Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers. Clin Biomech (Bristol, Avon), 2017, 49: 128-133.
42. Ranger TA, Cicuttini FM, Jensen TS, et al. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J, 2017, 17(11): 1729-1748.
43. Lee JH, Lee SH. Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black? Indian J Orthop, 2017, 51(2): 147-154.
44. 劉斌, 劉向陽, 王國平, 等. 腰椎骨質疏松性骨折患者椎旁肌肉 MRI 指標測量及臨床意義. 中國組織工程研究, 2019, 23(4): 578-583.
45. Jun HS, Kim JH, Ahn JH, et al. The effect of lumbar spinal muscle on spinal sagittal alignment: evaluating muscle quantity and quality. Neurosurgery, 2016, 79(6): 847-855.
46. Hiyama A, Katoh H, Sakai D, et al. The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis. BMC Musculoskelet Disord, 2019, 20(1): 352.
47. Banno T, Arima H, Hasegawa T, et al. The effect of paravertebral muscle on the maintenance of upright posture in patients with adult spinal deformity. Spine Deform, 2019, 7(1): 125-131.
48. 王雪鵬, 王圣杰, 晏鵬, 等. 椎旁肌肉損傷對腰椎椎體骨質量的影響. 中華醫學雜志, 2016, 96(43): 3515-3518.
49. Strube P, Putzier M, Streitparth F, et al. Postoperative posterior lumbar muscle changes and their relationship to segmental motion preservation or restriction: a randomized prospective study. J Neurosurg Spine, 2016, 24(1): 25-31.
50. Tandon R, Kiyawat V, Kumar N. Clinical correlation between muscle damage and Oswestry Disability Index Score after open lumbar surgery: Does open surgery reduces functional ability? Asian Spine J, 2018, 12(3): 518-523.

Chinese Journal of Reparative and Reconstructive Surgery

Progress on the evaluation method of paraspinal muscle and its correlation with lumbar diseases

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