CT imaging of multifidus muscles in sacralization

Main Article Content

Gali Dar Nathan Peled

Abstract

Background: The multifidus muscles are vital for spine stability and movement. Changes in muscle morphology are considered to be related to spine problems. The aim of this study was to examine multifidus muscles morphology in patients with sacralization.

Methods: Seventy CT images were examined for the presence of sacralization phenomena, using 3-D and 2-D images on the coronal and sagittal planes. Sacralization was identified as a partial or full fusion between the L5 transverse process and the sacrum. The cross-sectional area (in mm2) and fat infiltration (in Hounsfield units) were measured bilaterally on axial images on the L4 and L5 levels.

Results: Sacralization phenomena were found in 9 subjects (mean age 72 ±10.3 years). In order to age-match the controls, only 29 out of the 61 subjects were included in the analysis (mean age 69.9 ±7.9 years). Smaller cross-sectional areas of the multifidus muscles examined on both levels were observed in the sacralization group compared with the controls (not significant). The size of the muscles on the L4 level was larger than on the L5 level in the sacralization group. A significant difference (p<0.05) in fat infiltration was found between the L4 and L5 levels in both groups without a significant difference between groups.

Conclusion: Amongst the sacralization patients, the multifidus muscles were observed to be more active on the L4 level than the L5, although the total cross-sectional areas of the muscles were smaller compared to the controls. Fat infiltration within the muscles is not associated with the sacralization phenomena.

Article Details

How to Cite
DAR, Gali; PELED, Nathan. CT imaging of multifidus muscles in sacralization. Medical Research Archives, [S.l.], v. 5, n. 4, apr. 2017. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1152>. Date accessed: 28 sep. 2022.
Keywords
cross-sectional area, fat infiltration, transitional vertebra, paraspinal
Section
Research Articles

References

References
1. McGill SM, Grenier S, Kavcic N, Cholewicki, J. Coordination of muscle activity to assure stability of the lumbar spine. Journal of electromyography and kinesiology. 2003; 13(4), 353-359.‏
2. Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Manual Therapy. 2009; 14(5), 496-500.‏
3. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994; 19(2), 165-172.‏
4. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Manual therapy. 2008; 13(1), 43-49.‏
5. 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. European Spine Journal. 2000; 9(4), 266-272.‏
6. Hyun JK, Lee JY, Lee SJ, Jeon JY. Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy. Spine (Phila Pa 1976) 2007;32:E598–E602.
7. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine. 2004; 29(22), E515-E519‏.
8. Lee SH, Park SW, Kim YB, Nam TK, Lee YS. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. The Spine Journal. 2017; 17(1), 81-87.‏
9. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O'Sullivan R, Cicuttini FM. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. The Spine Journal. 2015; 15(7), 1593-1601.‏
10. Hildebrandt M, Fankhauser G, Meichtry A, Luomajoki H. Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain. BMC Musculoskeletal Disorders. 2017; 18(1), 12.‏
11. Crawford RJ, Filli L, Elliott JM, Nanz D, Fischer MA, Marcon M, Ulbrich EJ. Age-and level-dependence of fatty infiltration in lumbar paravertebral muscles of healthy volunteers. American Journal of Neuroradiology. 2016; 37(4), 742-748.‏
12. Hughes RJ, Saifuddin A. Imaging of lumbosacral transitional vertebrae. Clinical radiology. 2004; 59(11), 984-991.‏
13. Delport EG, Cucuzzella TR, Kim N, Marley J, Pruitt C, Delport AGLumbosacral transitional vertebrae: incidence in a consecutive patient series. Pain physician. 2006; 9(1), 53.‏
14. Bron JL, van Royen BJ, Wuisman, PI. The clinical significance of lumbosacral transitional anomalies. Acta Orthopaedica Belgica. 2007; 73(6), 687.‏
15. Lee CH, Park CM, Kim KA, Hong SJ, Seol HY, Kim BH, Kim JH. Identification and prediction of transitional vertebrae on imaging studies: anatomical significance of paraspinal structures. Clinical Anatomy. 2007; 20(8), 905-914.‏
16. Kim YH, Lee PB, Lee CJ, Lee SC, Kim YC, Huh J. Dermatome variation of lumbosacral nerve roots in patients with transitional lumbosacral vertebrae. Anesthesia & Analgesia. 2008; 106(4), 1279-1283.‏
17. Dar G, Peled N. The association between sacralization and spondylolisthesis. Anatomical science international. 2014; 89(3), 156-160.‏
18. Taskaynatan MA, Izci Y, Ozgul A, Hazneci B, Dursun H, Kalyon TA. Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain. Spine. 2005; 30(8), E210-E213.‏
19. Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional vertebrae in the lumbar spine. The Spine Journal. 2011; 11(9), 858-862.‏
20. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine. 1984; 9(5), 493-495.‏
21. Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihimäki H. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine. 2004; 29(2), 200-205.
22. Vergauwen S, Parizel PM, van Breusegem L, Van Goethem JW, Nackaerts Y, Van den Hauwe L, De Schepper AM. Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra. European Spine Journal. 1997; 6(3), 168-172.‏
23. Otani K, Konno S, Kikuchi S. Lumbosacral transitional vertebrae and nerve-root symptoms. Bone & Joint Journal. 2001; 83(8), 1137-1140.‏
24. Nardo L, Alizai H, Virayavanich W, Liu F, Hernandez A, Lynch JA, Nevitt MC, McCulloch CE, Lane NE, Link TM. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012; 265(2), 497-503.
25. Peterson CK, Bolton ., Hsu W, Wood A. A cross-sectional study comparing pain and disability levels in patients with low back pain with and without transitional lumbosacral vertebrae. Journal of manipulative and physiological therapeutics. 2005; 28(8), 570-574.‏
26. Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. American Journal of Neuroradiology. 2010; 31(10), 1778-1786.‏‏
27. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005; 60(7), 882-887.‏
28. Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine. 2006; 31(25), 2926-2933.‏
29. Chan ST, Fung PK, Ng NY, Ngan TL, Chong MY, Tang CN, He JF, Zheng YP. Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. The spine journal. 2012; 12(5), 381-388.‏
30. 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 medicine. 2007; 5(1), 2.
31. 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 1. Radiology. 2006; 240(3), 786-792.‏
32. Abbas J, Slon, V, May H, Peled N., Hershkovitz I, Hamoud, K. Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis?. BMC musculoskeletal disorders. 2016; 17(1), 422.‏
33. Akgul O, Gulkesen A, Akgol G, Ozgocmen S. MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis. Modern rheumatology. 2013; 23(4), 811-816.‏
34. Shafaq N, Suzuki A, Matsumura A, Terai H, Toyoda H, Yasuda H, Ibrahim M, Nakamura H. Asymmetric degeneration of paravertebral muscles in patients with degenerative lumbar scoliosis. Spine. 2012; 37(16), 1398-1406.‏
35. Kalichman L, Guermazi,A, Li L, Hunter DJ. Association between age, sex, BMI and CT-evaluated spinal degeneration features. Journal of back and musculoskeletal rehabilitation. 2009; 22(4), 189-195.‏