Can lumbar paraspinal muscle/fat ratio and spinopelvic parameters predict short-term outcomes after decompressive surgeries in lumbar disc herniation and lumbar spinal stenosis?
Journal of craniovertebral junction & spine
Background and Objectives:We aimed to investigate whether the lumbar paraspinal muscle/fat ratio influences the outcomes of patients who had simple decompressive surgeries for lumbar disc herniation (LDH) or lumbar spinal stenosis. We also wanted to see if the spinopelvic parameters change with surgery and whether this change influences the outcomes. Materials and Methods:This was a prospective study on patients with lumbar spinal stenosis (20 patients) and LDH (20 patients) who underwent simple discectomy or decompressive surgery between November 2021 and May 2022. Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index, and Japanese Orthopedic Association (JOA) score were performed before and 3 months after surgery. Spinopelvic parameters were measured on whole spine radiographs before and 3 months after surgery. On axial magnetic resonance images, paraspinal muscle volume and muscle/fat ratios were calculated. All data were statistically analyzed with SPSS program. Results:There was a significant improvement in VAS, Oswestry, and JOA scores after surgery. We observed that more preoperative paraspinal muscle mass was positively correlated with lumbar lordosis (LL) and negatively correlated with sagittal vertical axis (SVA), VAS leg scores, and Oswestry scores. Furthermore, we observed a positive correlation between preoperative SVA and VAS leg scores. Conclusion:Despite limited number of patients, and shorter follow-ups, this prospective study demonstrates a correlation among the lumbar paraspinal muscle/fat ratio, preoperative/postoperative spinopelvic parameters, and surgical outcomes. Increased paraspinal muscle ratio was correlated with lower SVA values and increased LL; lower VAS leg scores; higher Oswestry scores which reflects better surgical outcomes.
10.4103/jcvjs.jcvjs_40_23
Enhanced grading methods for lumbar paraspinal fat infiltration and its prognostic value in predicting lumbar disc herniation.
Journal of orthopaedic surgery and research
BACKGROUND:The simplified 3-grade system for measuring fat infiltration in the paraspinal muscles is widely utilized. In comparing our proposed 4-grade system to the existing 3-grade system, we evaluated its impact on results and particularly its ability to predict disc herniation, ultimately highlighting deficiencies in the latter. The objective of this investigation was to validate the efficacy of our newly proposed semi-quantitative simplified 4-grade system for assessing fat infiltration, as compared to the existing literature-based simplified 3-grade system, in terms of their predictive value for lumbar disc herniation. METHODS:Infiltration of the right and left lumbar multifidus and erector spinae muscles were assessed using a semi-quantitative 3- and 4-grade fat infiltration system on axial magnetic resonance imaging sections at the L3-S1 level in all subjects, with comparison of results between groups. The correlation between these grading systems and lumbar disc herniation was investigated. RESULTS:The simplified 3-degree system for measuring fat infiltration was not effective in predicting lumbar disc herniation (p > 0.05), while the 4-degree system proved to be useful in predicting it (p < 0.05). In both grading systems, females were found to have a higher risk of lumbar disc herniation than males (p < 0.05), and the risk increased with age and body mass index (BMI) (p < 0.001). CONCLUSIONS:It was observed that using the 4-grade fat infiltration system to determine the level of fat infiltration in the paraspinal muscles is more effective in predicting lumbar disc herniation compared to the 3-grade system. The 4-grade fat infiltration grading system proves to be an efficient semi-quantitative method that can replace the simplified 3-grade system.
10.1186/s13018-023-04247-w
Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia.
Younes Mohamed,Béjia Ismail,Aguir Zouhour,Letaief Mondher,Hassen-Zrour Saoussen,Touzi Mongi,Bergaoui Naceur
Joint bone spine
BACKGROUND:Disk-related sciatica (DRS) creates a public health burden because of its high incidence and considerable socioeconomic costs. We are not aware of previous epidemiological studies of the prevalence and risk factors of DRS in Tunisia or other Arab countries, and few studies have addressed these issues elsewhere. OBJECTIVES:To determine the prevalence and incidence of DRS in Monastir, Tunisia; to look for risk factors; and to evaluate socioeconomic costs. METHODS:Data on a cross-section of 5000 individuals aged 15 years or older living in Monastir were collected by interviewers using a previously developed 51-item questionnaire. RESULTS:The study participation rate was 87.6%. The annual prevalence of DRS was 2.21% and the incidence was 1.44%. Among the patients with DRS, 94.8% received healthcare interventions, 64% had plain radiographs taken, and 45.4% underwent computed tomography of the lumbar spine. Sick leaves were given to 77.7% of patients, and mean sick leave duration was 9 weeks. A change in job was required in 5.5% of cases. Factors associated with DRS included male gender (P<0.001), obesity (P<0.0001), smoking (P<0.0001), a history of low back problems (P<0.0001), anxiety and depression (P<0.0001), a job requiring prolonged standing and bending forward (P<0.03), heavy manual labor (P<0.005), heavy lifting (P<0.0001), and exposure to vibrations (P<0.0001). CONCLUSION:The prevalence of DRS in Monastir is 2.2%. We identified a number of patient- and occupation-related risk factors. The high socioeconomic cost should encourage preventive measures.
10.1016/j.jbspin.2005.10.022
Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety.
Artner Juraj,Cakir Balkan,Weckbach Sebastian,Reichel Heiko,Lattig Friederike
Patient safety in surgery
BACKGROUND:Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. METHODS:We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011) at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30), coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2), the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. RESULTS:A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31%) was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. CONCLUSIONS:Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient safety of stochastic radiation effects.
10.1186/1754-9493-6-19
[Distribution characteristics of Modic changes of lumbar endplate and its relationship with low back pain].
Han Chao,Ma Xinlong,Ma Jianxiong,Wang Tao,Wang Pei
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery
OBJECTIVE:To investigate the incidence of Modic changes of lumbar endplate and its clinical significances. METHODS:The imaging data of 562 patients (2,810 lumbar intervertebral discs) with lumbar degenerative disease undergoing posterior operation from June 2006 to June 2009 were retrospectively reviewed. There were 297 males and 265 females aged 26-77 years old (average 49 years old). The course of disease was 2 months to 40 years (median 10.4 years). Imaging examinations excluded the tuberculosis, cancer, infection, trauma, etc. The association of Modic changes with low back pain (LBP) and patients' weight was analyzed according to the incidence and types of Modic changes as well as the distribution of gender, age and disc level through imaging data of MRI. RESULTS:Modic changes were observed in 106 patients (18.9%) of 113 intervertebral discs, including 40 (13.5%) males and 66 (24.9%) females. The difference between male proportion and female proportion had a significant difference (P < 0.05). Modic changes was distributed from age 26 to 77 years old (average 49 years old). Among all the patients, 33 cases (5.9%) were type I, 66 cases (11.7%) were type II, and 7 cases (1.2%) were type III. According to the segment, the lesions involved L5, S1 disc for 58 discs (51.3%), L4, 5 for 35 (31.0%), L3, 4 for 11 (9.7%), L2, 3 for 6 (5.3%), and L1, 2 for 3 (2.7%). The incidence of Modic change was 15.5% (41/264) in the normal body weight group, 16.3% (34/208) in the over-weight group, and 34.4% (31/90) in the obesity group. There was a significant association between obesity and the Modic change (P < 0.05). Preoperatively, there were 59 patients (55.7%) with LBP in the Modic group, including 27 cases of type I Modic change, 27 cases of type II Modic change, and 5 cases of type III Modic change. Postoperatively, the LBP of 40 patients (67.8%) were relieved, including 24 cases of type I Modic change, 14 cases of type II Modic change, and 2 cases of type III Modic change. In non-Modic change group, there were 126 patients (27.6%) with LBP preoperatively, and 96 patients (76.2%) eased the symptoms postoperatively. There was significant difference between two groups on incidence rate (P < 0.05), but no significant difference on the remission rate of LBP (P > 0.05). CONCLUSION:The most common Modic change is type II and the most frequently involved level is the L5, S1. Modic changes are more common in female than in male and mainly happen to the obesity group. The incidence of LBP is higher in the patients with Modic change.
Incidence and trends of low back pain hospitalisation during military service--an analysis of 387,070 Finnish young males.
Mattila Ville M,Sillanpää Petri,Visuri Tuomo,Pihlajamäki Harri
BMC musculoskeletal disorders
BACKGROUND:There is evidence that low back pain (LBP) during young adulthood and military service predicts LBP later in life. The purpose of this study was to investigate the incidence and trends of LBP hospitalisation among Finnish military conscripts. METHODS:All male conscripts performing their compulsory military service during 1990-2002 were included in the study population. Altogether 387,070 military conscripts were followed throughout their six-to-twelve-month service period. Data on LBP hospitalisations were obtained from the National Hospital Discharge Register. RESULTS:Altogether 7,240 LBP hospitalisations were identified among 5,061 (1.3%) male conscripts during the study period. The event-based incidence of LBP hospitalisation was 27.0 (95% confidence interval (CI): 25.7-28.2). In most cases, the diagnosis was unspecified LBP (n = 5,141, 71%) followed by lumbar disc disorders (n = 2,069, 29%). Hospitalisation incidence due to unspecified LBP was 19.1 per 1,000 person-years (95% CI: 18.3 to 20.4), and 7.8 per 1,000 person-years (95% CI: 6.7 to 8.3) due to lumbar disc disorders. The incidence of unspecified LBP remained unaltered, while hospitalisation due to lumbar disc disorders declined from 1993 onwards. CONCLUSION:Although conscripts accepted into military training pass physician-performed examinations as healthy, young adults, LBP hospitalisation causes significant morbidity during military service.
10.1186/1471-2474-10-10
Predictors of new vertebral endplate signal (Modic) changes in the general population.
Jensen Tue Secher,Kjaer Per,Korsholm Lars,Bendix Tom,Sorensen Joan S,Manniche Claus,Leboeuf-Yde Charlotte
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Vertebral endplate signal changes (VESC), also known as Modic changes, have been reported to be associated with low back pain (LBP). However, little is known about predisposing factors for the development of new VESC. The aim of this study was to investigate the predictive value of lifestyle factors and disc-related magnetic resonance imaging (MRI) findings in relation to the development of new VESC. This prospective observational study included 344 people from the Danish general population who had an MRI and completed LBP questionnaires at the age of 40 and again at 44 years. Potential predictors of new VESC were female gender, disc-related MRI findings (disc degeneration, disc bulges, disc herniation, and other endplate changes) and lifestyle factors [high physical work or leisure activity, high body mass index (BMI), and heavy smoking]. Bivariate and multivariate logistic regressions were used to identify predictors of new VESC. New VESC at the age of 44 appeared in 67 of the 344. The majority (84%) of these new signal changes were type 1 VESC and almost half (45%) were only in the endplate and did not extend into the vertebral body. In the multivariate analysis, lumbar disc levels with disc degeneration, bulges or herniations at 40 were the only predictors of new VESC at age 44. Therefore, the development of new VESC at the age of 44 appears to be based on the status and dynamics of the disc, rather than being the result of gender or lifestyle factors such as smoking and physical load.
10.1007/s00586-009-1184-5
[Clinical and radiographic factors associated with the severity of paraspinal fatty infiltration in patients with degenerative low back disease].
Acta ortopedica mexicana
INTRODUCTION:Degenerative lumbar disease (DLE) is a spectrum of pathological changes from disc degeneration, herniated disc, spondylolisthesis and lumbar canal stenosis. The pain associated with it is multifactorial. Muscle cramps are among the most frequent causes. The relationship between muscle degeneration and DLE has already been studied in the past in multiple studies, highlighting the one carried out by Kjaer & cols. OBJECTIVE:to determine the prevalence and severity of fatty degeneration in mutifidus spinae, and to study its relationship with clinical and radiographic factors. MATERIAL AND METHODS:observational and analytical study. Patients diagnosed with: herniated disc, lumbar canal stenosis or degenerative scoliosis were included. They were classified according to the Kjaer scale for paraspinal fatty infiltration in one of three groups. Clinical variables were analyzed: age, smoking, obesity, the presence of axial pain, temporality of pain, severity expressed with a visual analog scale (VAS); and radiographic: number of diseased segments, involved segments, diagnostic imaging and the presence of spondylolisthesis. RESULTS:56 patients with an average age of 52.5 years (16 to 80) with a predominance of females with 62.5% were included. The diagnoses were nonspecific low back pain (1.8%), herniated disc (42.9%), narrow lumbar duct (46.4%) and lumbar duct with degenerative scoliosis deformity (8.9%). The distribution among the three groups described by Kjaer was as follows: 44.6% were classified with a fat infiltration score of 2. In groups 1 and 0, 39.3% and 16.1% were classified respectively. The variables significantly related to greater fat infiltration were: age > 60 years, diagnoses of lumbar canal stenosis and herniated disc; obesity, spondylolisthesis < 2 vertebral segments involved. Axial pain and VAS > 8 points were not related to greater muscle degeneration. CONCLUSIONS:fatty infiltration is present in all patients with some of the forms of DLE. Most patients > 60 years of age with advanced degenerative processes have a greater severity of infiltration. Other related variables are: obesity, spondylolisthesis and disease of < 2 vertebral segments. There is no relationship between a higher percentage of fatty infiltration and axial pain or higher VAS scores.
[Obesity and low back pain--biology, biomechanics and epidemiology].
Flamme C H
Der Orthopade
Aim of the following paper is to describe the impact of obesity on low back pain. The mature disc is one of the most sparsely cellular tissues in the body, water content and concentration of proteoglycan decreases with increasing age. Both, static compressive loading and increased pressures, may result in damage of the integrity of the disc like tears of the anulus, followed by mechanical compression or chemical damage of the nerve roots. The intradiscal pressure is dependent on the body position and increases in the following order: prone, standing, upright sitting. In addition, bending and weight lifting increases the intradiscal pressure. For asymptomatic subjects, reported prevalences of disc degenerations in MRI studies are often quite high. Several studies report a significant association between body weight and low back pain, some do not. Recent research indicates that heredity has a dominant role in disc degeneration and low back pain, although the complex distributions and interactions of genetic factors are currently unknown.
10.1007/s00132-005-0817-6
Cross-sectional magnetic resonance imaging study of lumbar disc degeneration in 200 healthy individuals.
Kanayama Masahiro,Togawa Daisuke,Takahashi Chihiro,Terai Tomoya,Hashimoto Tomoyuki
Journal of neurosurgery. Spine
OBJECT:The current cross-sectional observational MR imaging study aimed to investigate the prevalence and risk factors of lumbar disc degeneration in a healthy population and to establish the baseline data for a prospective longitudinal study. METHODS:Two hundred healthy volunteers participated in this study after providing informed consent. The status of lumbar disc degeneration was assessed by 3 independent observers, who used sagittal T2-weighted MR imaging. Demographic data collected included age, sex, body mass index, episode(s) of low-back pain, smoking status, hours of standing and sitting, and Roland-Morris Disability Questionnaire scores. There were 68 men and 132 women whose mean age was 39.7 years (range 30-55 years). Eighty-two individuals (41%) were smokers, and the Roland-Morris Disability Questionnaire scores were averaged to 0.6/24. RESULTS:The prevalence of disc degeneration was 7.0% in L1-2, 12.0% in L2-3, 15.5% in L3-4, 49.5% in L4-5, and 53.0% in L5-S1. A herniated disc was observed at the corresponding levels in 0.5, 3.5, 6.5, 25.0, and 35.0% of cases respectively. Spondylolisthesis was observed in < 3% of this population. Multiple logistic regression analysis demonstrated that age and hours sitting were significantly related to L4-5 disc herniation. Episode of low-back pain, smoking status, body mass index, and hours standing did not affect the prevalence of disc degeneration. CONCLUSIONS:The current study established the baseline data of lumbar disc degeneration in a 30- to 55-year-old healthy population for a prospective longitudinal study. Hours spent sitting significantly increased the prevalence of disc herniation, but episode of low-back pain, smoking status, obesity, and standing hours were not significant risk factors.
10.3171/2009.5.SPINE08675
A comparison of lumbar spine and muscle loading between male and female workers during box transfers.
Gagnon Denis,Plamondon André,Larivière Christian
Journal of biomechanics
There is a clear relationship between lumbar spine loading and back musculoskeletal disorders in manual materials handling. The incidence of back disorders is greater in women than men, and for similar work demands females are functioning closer to their physiological limit. It is crucial to study loading on the spine musculoskeletal system with actual handlers, including females, to better understand the risk of back disorders. Extrapolation from biomechanical studies conducted on unexperienced subjects (mainly males) might not be applicable to actual female workers. For male workers, expertise changes the lumbar spine flexion, passive spine resistance, and active/passive muscle forces. However, experienced females select similar postures to those of novices when spine loading is critical. This study proposes that the techniques adopted by male experts, male novices, and females (with considerable experience but not categorized as experts) impact their lumbar spine musculoskeletal systems differently. Spinal loads, muscle forces, and passive resistance (muscle and ligamentous spine) were predicted by a multi-joint EMG-assisted optimization musculoskeletal model of the lumbar spine. Expert males flexed their lumbar spine less (avg. 21.9° vs 30.3-31.7°) and showed decreased passive internal moments (muscle avg. 8.9% vs 15.9-16.0%; spine avg. 4.7% vs 7.1-7.8%) and increased active internal moments (avg. 72.9% vs 62.0-63.9%), thus producing a different impact on their lumbar spine musculoskeletal systems. Experienced females sustained the highest relative spine loads (compression avg. 7.3 N/BW vs 6.2-6.4 N/BW; shear avg. 2.3 N/BW vs 1.7-1.8 N/BW) in addition to passive muscle and ligamentous spine resistance similar to novices. Combined with smaller body size, less strength, and the sequential lifting technique used by females, this could potentially mean greater risk of back injury. Workers should be trained early to limit excessive and repetitive stretching of their lumbar spine passive tissues.
10.1016/j.jbiomech.2018.09.017
Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration.
Spine
STUDY DESIGN:Retrospective chart analysis of 199 individuals aged 18 to 80 years scheduled for lumbar spine surgery. OBJECTIVE:The purpose of this study was to quantify changes in muscle cross-sectional area (CSA) and fat signal fraction (FSF) with age in men and women with lumbar spine pathology and compare them to published normative data. SUMMARY OF BACKGROUND DATA:Pathological changes in lumbar paraspinal muscle are often confounded by age-related decline in muscle size (CSA) and quality (fatty infiltration). Individuals with pathology have been shown to have decreased CSA and fatty infiltration of both the multifidus and erector spinae muscles, but the magnitude of these changes in the context of normal aging is unknown. METHODS:Individuals aged 18 to 80 years who were scheduled for lumbar surgery for diagnoses associated with lumbar spine pain or pathology were included. Muscle CSA and FSF of the multifidus and erector spinae were measured from preoperative T2-weighted magnetic resonance images at the L4 level. Univariate and multiple linear regression analyses were performed for each outcome using age and sex as predictor variables. Statistical comparisons of univariate regression parameters (slope and intercept) to published normative data were also performed. RESULTS:There was no change in CSA with age in either sex (P > 0.05), but women had lower CSAs than men in both muscles (P < 0.0001). There was an increase in FSF with age in erector spinae and multifidus muscles in both sexes (P < 0.0001). Multifidus FSF values were higher in women with lumbar spine pathology than published values for healthy controls (P = 0.03), and slopes tended to be steeper with pathology for both muscles in women (P < 0.08) but not in men (P > 0.31). CONCLUSION:Lumbar muscle fat content, but not CSA, changes with age in individuals with pathology. In women, this increase is more profound than age-related increases in healthy individuals. LEVEL OF EVIDENCE:3.
10.1097/BRS.0000000000001848
Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study.
Murray Kelvin J,Le Grande Michael R,Ortega de Mues Arantxa,Azari Michael F
BMC musculoskeletal disorders
BACKGROUND:Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Excessive loading of lumbar joints is a risk factor for DJD. Changes in lumbar lordosis significantly redistribute the forces of weight-bearing on the facet joints and the intervertebral discs. However, the relationship between lumbar lordosis and DJD has not been characterized in men and women. METHODS:We characterised the correlation between standing lumbar lordosis and DJD in standing radiographic images from 301 adult female and male chiropractic patients. DJD was rated using the Kellgren-Lawrence scale, and lordosis was measured using the Cobb angle. Linear and curvilinear correlations were investigated while controlling for age and sex. RESULTS:We found a highly significant curvilinear correlation between lordosis and DJD of the lower lumbar spine in both sexes, but especially in women, irrespective of the effects of age. We found the effect size of lordosis on lower lumbar DJD to be between 17.4 and 18.1% in women and 12.9% in older men. In addition, lordosis of 65 (95% CI 55.3-77.7) and 68 (98% CI 58.7-73.3) degrees were associated with minimal DJD in the lower lumbar spine of women and men respectively, and were therefore considered 'optimal'. This optimal lordotic angle was 73 (95% CI 58.8-87.2) degrees in older men. CONCLUSIONS:Both hypo- and hyper-lordosis correlate with DJD in the lumbar spine, particularly in women and in older men. These findings may well be of relevance to spinal pain management and spinal rehabilitation.
10.1186/s12891-017-1696-9
Are lumbar multifidus fatigue and transversus abdominis activation similar in patients with lumbar disc herniation and healthy controls? A case control study.
Ramos Luiz Armando Vidal,França Fábio Jorge Renovato,Callegari Bianca,Burke Thomaz Nogueira,Magalhães Maurício Oliveira,Marques Amélia Pasqual
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:The aims of this study were to assess lumbar multifidus fatigue (LM) and transversus abdominis activation (TrA) in individuals with lumbar disc herniation associated with low back pain. METHODS:Sixty individuals were divided into the lumbar herniation (LHG, n = 30) and control groups (CG, n = 30). Fatigue of the LM was assessed using surface electromyography during the Sorensen effort test, and activation of the TrA with a pressure biofeedback unit. Pain intensity was determined using a visual analog scale and the McGill pain questionnaire. The Oswestry disability questionnaire and the Borg scale for self-evaluating exertion were used to assess functional disability. RESULTS:Fatigue was significantly more intense and the TrA activation was insufficient (p < 0.01) in individuals with disc herniation relative to the control group. The LHG had mild functional disability and moderate pain. There were differences in the initial exertion self-evaluation between groups, which were not observed in the final exertion evaluation. CONCLUSION:Individuals with lumbar disc herniation associated with low back pain have increased fatigue of the LM and decreased activation of the TrA, when compared to the control group.
10.1007/s00586-015-4375-2
The Effect of Lumbar Disc Herniation on Musculoskeletal Loadings in the Spinal Region During Level Walking and Stair Climbing.
Kuai Shengzheng,Liao Zhenhua,Zhou Wenyu,Guan Xinyu,Ji Run,Zhang Rui,Guo Daiqi,Liu Weiqiang
Medical science monitor : international medical journal of experimental and clinical research
BACKGROUND People with low back pain (LBP) alter their motion patterns during level walking and stair climbing due to pain or fear. However, the alternations of load sharing during the two activities are largely unknown. The objective of this study was to investigate the effect of LBP caused by lumbar disc herniation (LDH) on the muscle activities of 17 main trunk muscle groups and the intradiscal forces acting on the five lumbar discs. MATERIAL AND METHODS Twenty-six healthy adults and seven LDH patients were recruited to perform level walking and stair climbing in the Gait Analysis Laboratory. Eight optical markers were placed on the bony landmarks of the spinous process and pelvis, and the coordinates of these markers were captured during the two activities using motion capture system. The coordinates of the captured markers were applied to developed musculoskeletal model to calculate the kinetic variables. RESULTS LDH patients demonstrated higher muscle activities in most trunk muscle groups during both level walking and stair climbing. There were decreases in anteroposterior shear forces on the discs in the pathological region and increases in the compressive forces on all the lumbar discs during level walking. The symmetry of mediolateral shear forces was worse in LDH patients than healthy adults during stair climbing. CONCLUSIONS LDH patients exhibited different kinetic alternations during level walking and stair climbing. However, both adaptive strategies added extra burdens to the trunk system and further increased the risk for development of LDH.
10.12659/msm.903349
Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects?
BMC public health
BACKGROUND:Obesity is associated with metabolic risk factors. Body mass index (BMI), waist circumference, waist-hip ratio (WHR) and waist-height ratio (WHtR) are used to predict the risk of obesity related diseases. However, it has not been examined whether these four indicators can detect the clustering of metabolic risk factors in Chinese subjects. METHODS:There are 772 Chinese subjects in the present study. Metabolic risk factors including high blood pressure, dyslipidemia, and glucose intolerance were identified according to the criteria from WHO. All statistical analyses were performed separately according to sex by using the SPSS 12.0. RESULTS:BMI, waist circumference and WHtR values were all significantly associated with blood pressure, glucose, triglyceride and also with the number of metabolic risk factors in both male and female subjects (all of P < 0.05). According to receiver operating characteristic (ROC) analysis, the area under curve values of BMI, waist circumference and WHtR did not differ in male (0.682 vs. 0.661 vs. 0.651) and female (0.702 vs. 0.671 vs. 0.674) subjects, indicating that the three values could be useful in detecting the occurrence of multiple metabolic risk factors. The appropriate cut-off values of BMI, waist circumference and WHtR to predict the presence of multiple metabolic risk factors were 22.85 and 23.30 kg/m² in males and females, respectively. Those of waist circumference and WHtR were 91.3 cm and 87.1 cm, 0.51 and 0.53 in males and females, respectively. CONCLUSION:The BMI, waist circumference and WHtR values can similarly predict the presence of multiple metabolic risk factors in Chinese subjects.
10.1186/1471-2458-11-35
The Effects of Electrical Acupuncture and Essential Amino Acid Supplementation on Sarcopenic Obesity in Male Older Adults: A Randomized Control Study.
Zhou Xin,Xing Bingfeng,He Guanheng,Lyu Xiaozhou,Zeng Yi
Obesity facts
OBJECTIVE:Aging which is accompanied by loss of skeletal muscle and increase of body fat in some adults older than 60 years does not only result in remarkable influences on daily life function but also increases the risk of cardiovascular events. This study used electrical acupuncture together with essential amino acid supplementation to treat sarcopenic obesity (SO) in male older adults. METHODS:A total of 48 male participants with SO (>60 years old) were randomized to electrical acupuncture with oral essential amino acids (EA + AA) or oral essential amino acids alone (AA). Acupuncture points on the limbs were punctured and stimulated electrically once every 3 days for 12 weeks. All participants received essential amino acids orally, twice per day for 28 weeks. Body fat percentage (BFP) and appendicular skeletal muscle index (ASM/H2) was determined by bioelectrical impedance analysis. RESULTS:Both groups exhibited significant changes in BFP after 12, 20, and 28 weeks compared with baseline values; for ASM/H2, there were significant differences to baseline values after 12, 20, and 28 weeks in the EA + AA group, but only after 28 weeks in the AA group. Between the two groups, there were significant differences in BFP after 12, 20, and 28 weeks, and in ASM/H2 after 20 and 28 weeks. CONCLUSION:Both methods decrease BFP and increase ASM/H2. In male older adults, electrical acupuncture with oral essential amino acids is more effective and can increase muscle mass in a shorter time than oral essential amino acids alone.
10.1159/000491797
Sex Differences in Inflammatory Responses to Adipose Tissue Lipolysis in Diet-Induced Obesity.
Varghese Mita,Griffin Cameron,McKernan Kaitlin,Eter Leila,Lanzetta Nicholas,Agarwal Devyani,Abrishami Simin,Singer Kanakadurga
Endocrinology
Males are known to have profound adipose tissue macrophage (ATM) accumulation in gonadal white adipose tissue (GWAT) during obesity, whereas females are protected from such an inflammatory response even with increased adiposity. The inflammatory tone in males is linked to insulin resistance and might be the underlying cause for sex differences in metabolic disease. Factors regulating the meta-inflammatory response remain unclear but enhanced lipid storage in females may explain the reduced inflammatory response to high-fat diets. In this study, we evaluated lean and obese females with stimulated lipolysis to understand whether a stress release of free fatty acids (FFAs) could induce female ATMs. We demonstrate that in both lean and obese females, GWAT CD11c- resident ATMs accumulate with β-3 adrenergic receptor-stimulated lipolysis. Lipolysis elevated serum FFA, triglyceride, and IL-6 levels in females that corresponded to significant phosphorylated hormone-sensitive lipase and adipose triglyceride lipase protein expression in obese female GWAT compared with males. Increased lipolytic response in obese females was associated with crown-like structures and induced Il6, Mcp1, Arg1, and Mgl1 expression in obese female GWAT, suggesting an environment of lipid clearance and adipose remodeling. With this finding we next investigated whether lipid storage and lipolytic mediators differed by sex. Diacylglycerol, ceramides, phospholipids, and certain fatty acid species associated with inflammation were elevated in male GWAT compared with obese female GWAT. Overall, our data demonstrate a role for GWAT lipid storage and lipolytic metabolites to induce inflammation in males and induce remodeling in females that might explain sex differences in overall metabolic health.
10.1210/en.2018-00797
Cellular Mechanisms Driving Sex Differences in Adipose Tissue Biology and Body Shape in Humans and Mouse Models.
Karastergiou Kalypso,Fried Susan K
Advances in experimental medicine and biology
Sex differences in adipose tissue distribution and the metabolic, endocrine, and immune functions of different anatomical fat depots have been described, but they are incompletely documented in the literature. It is becoming increasingly clear that adipose depots serve distinct functions in males and females and have specific physiological roles. However, the mechanisms that regulate the size and function of specific adipose tissues in men and women remain poorly understood. New insights from mouse models have advanced our understanding of depot differences in adipose growth and remodeling via the proliferation and differentiation of adipose progenitors that can expand adipocyte number in the tissue or simply replace dysfunctional older and larger adipocytes. A limited ability of a depot to expand or remodel can lead to excessive adipocyte hypertrophy, which is often correlated with metabolic dysfunction. However, the relationship of adipocyte size and function varies by depot and sex. For example, femoral adipose tissues of premenopausal women appear to have a greater capacity for adipose expansion via hyperplasia and hypertrophy; although larger, these gluteal-femoral adipocytes remain insulin sensitive. The microenvironment of specific depots, including the composition of the extracellular matrix and cellular composition, as well as cell-autonomous genetic differences, influences sex- and depot-dependent metabolic and growth properties. Although there are some species differences, studies of the molecular and physiological determinants of sex differences in adipocyte growth and function in humans and rodents are both needed for understanding sex differences in health and disease.
10.1007/978-3-319-70178-3_3
Targeting thermogenesis in brown fat and muscle to treat obesity and metabolic disease.
Betz Matthias J,Enerbäck Sven
Nature reviews. Endocrinology
Brown fat is emerging as an interesting and promising target for therapeutic intervention in obesity and metabolic disease. Activation of brown fat in humans is associated with marked improvement in metabolic parameters such as levels of free fatty acids and insulin sensitivity. Skeletal muscle is another important organ for thermogenesis, with the capacity to induce energy-consuming futile cycles. In this Review, we focus on how these two major thermogenic organs - brown fat and muscle - act and cooperate to maintain normal body temperature. Moreover, in the light of disease-relevant mechanisms, we explore the molecular pathways that regulate thermogenesis in brown fat and muscle. Brown adipocytes possess a unique cellular mechanism to convert chemical energy into heat: uncoupling protein 1 (UCP1), which can short-circuit the mitochondrial proton gradient. However, recent research demonstrates the existence of several other energy-expending 'futile' cycles in both adipocytes and muscle, such as creatine and calcium cycling. These mechanisms can complement or even substitute for UCP1-mediated thermogenesis. Moreover, they expand our view of cold-induced thermogenesis from a special feature of brown adipocytes to a more general physiological principle. Finally, we discuss how thermogenic mechanisms can be exploited to expend energy and hence offer new therapeutic opportunities.
10.1038/nrendo.2017.132
An Early Disc Herniation Identification System for Advancement in the Standard Medical Screening Procedure Based on Bayes Theorem.
Sustersic Tijana,Rankovic Vesna,Peulic Miodrag,Peulic Aleksandar
IEEE journal of biomedical and health informatics
The aim of this research was to analyze objectively the process of disc herniation identification using Bayes Theorem. One of the symptoms of discus hernia is muscle weakness on the foot that is caused by displaced discs in the space of two vertebrae. This fact is used by experts in initial diagnosis of herniated discs and we used it to create non-invasive platform for the same purposes by measuring force values from four sensors placed on both feet (first, second, and fourth metatarsal head as well as the heel). Dataset consisted of several minute force recordings of 56 subjects with discus hernia and 15 healthy individuals during normal standing, standing on forefeet and heels. The subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Collected recordings were processed in several steps including filtering, extraction of forefeet and heel recordings, classification of average values for forefeet, and heel sensors to the groups with or without foot muscle weakness. Application of Bayes Theorem on the attributes of interest showed average 78.3% accuracy with 62.6% sensitivity and 80.9% specificity, while application of naive Bayes Network showed average 83.1% accuracy with 57.6% sensitivity and 88.2% specificity. Very weak or no correlation was observed between gender and disc hernia diagnosis (or obesity type and disc hernia diagnosis). Obtained results show that this method can be used in initial screening of patients and be a supportive tool to doctors to send the same patients for further examination.
10.1109/JBHI.2019.2899665
A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain.
Pain and therapy
PURPOSE OF THE REVIEW:Chronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain. RECENT FINDINGS:A systematic review of relevant literature was conducted. CENTRAL, MEDLINE, EMBASE, PubMed, and two clinical trials registry databases up to 24 June 2015 were included in this review. Search terms included: low back pain, over the counter, non-steroidal anti-inflammatory (NSAID), CLBP, ibuprofen, naproxen, acetaminophen, disk herniation, lumbar spondylosis, vertebral compression fractures, spondylolisthesis, and lumbosacral muscle strain. Over-the-counter analgesics are the most frequently used first-line medication for LBP, and current guidelines indicate that over-the-counter medications should be the first prescribed treatment for non-specific LBP. Current literature suggests that NSAIDs and acetaminophen as well as antidepressants, muscle relaxants, and opioids are effective treatments for CLBP. Recent randomized controlled trials also evaluate the benefit of buprenorphine, tramadol, and strong opioids such as oxycodone. This systematic review discusses current evidence pertaining to non-prescription treatment options for chronic low back pain.
10.1007/s40122-020-00209-w
Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort.
Mok Florence P S,Samartzis Dino,Karppinen Jaro,Fong Daniel Y T,Luk Keith D K,Cheung Kenneth M C
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Modic changes (MC) are bone marrow lesions on magnetic resonance imaging (MRI), suggestive of being associated with low back pain (LBP). Data on determinants of MC and their association with disc degeneration and other spinal phenotypes, as well as that of LBP, rely mostly on small-scale patient populations and remain controversial. PURPOSE:This study addressed the potential determinants of MC and their association with disc degeneration and LBP among Southern Chinese. STUDY DESIGN/SETTING:A cross-sectional, population-based study was carried out. PATIENT SAMPLE:This study consisted of 2,449 Southern Chinese volunteers. METHODS:Sagittal T2-weighted MRIs of the lumbar spine were assessed for the presence of MC and other spinal phenotypes (eg, disc degeneration, disc displacement, Schmorl nodes) in all individuals. Subjects' demographics, occupation, lifestyle, and clinical profiles were assessed. RESULTS:The overall prevalence of MC was 5.8% (n=141), which increased with advancing age. Modic changes predominantly occurred at the lowest two lumbar levels (83%). In the multivariate analyses, only the presence of disc displacement and a higher disc degeneration score were associated with MC at the upper lumbar levels (L1/L2-L3/L4) (p<.01). The presence of MC at the lowest two lumbar levels (L4/L5-L5/S1) were associated with age, the presence of Schmorl nodes, disc degeneration or displacement, and historical lumbar injury (p<.01). Subjects who were both smokers and overweight or obese had increased likelihood of MC in the lower spine (OR: 2.18; 95% CI: 1.10-4.30). The presence of MC at the lower lumbar levels were associated with historical LBP (OR: 1.93; 95% CI: 1.05-3.54) and with severity and duration of symptoms (p<.05). CONCLUSIONS:Based on one of the largest MRI studies to assess lumbar MC, we noted that MC were associated with both disc degeneration and the presence and severity of LBP. Determinants and association of MC with disc degeneration and clinical symptoms in the upper versus the lower lumbar spine were different. Our study further stresses the significance of MC as important imaging phenotypes associated with LBP.
10.1016/j.spinee.2015.09.060
Association Between Overweight or Obesity and Lumbar Disk Diseases: A Meta-Analysis.
Xu Xian,Li Xu,Wu Wei
Journal of spinal disorders & techniques
STUDY DESIGN:A meta-analysis. OBJECTIVE:We performed this meta-analysis to evaluate the association between overweight and lumbar disease. SUMMARY OF BACKGROUND DATA:An extensive English language literature retrieval regarding the association between overweight and the risk of lumbar disease was conducted on Public Medline and Excerpta Medica Database until May 2014. METHODS:Meta-analysis for all the included literatures was performed by STATA 11.0 to summarize test performance with forest plots after heterogeneity test. Moreover, subgroup and sensitivity analyses were performed to examine the potential candidate effect factors. Afterward, the likelihood of publication bias was assessed by constructing funnel plots and performing Begg rank correlation test and Egger linear regression method. RESULTS:A total of 5 studies satisfied the predefined eligibility criteria, including 1749 cases with lumbar disk diseases and 1885 controls. Altogether, overweight was associated with increased risk of lumbar disease [odds ratio (OR)=1.45; 95% confidence interval (CI), 1.27, 1.66; P<0.001]. Moreover, subgroup analysis proved that overweight was a predominant factor in development of lumbar disease compared with age and sex. Although significant publication bias was observed in our meta-analysis, we proved high credibility of meta-analysis result using trim and fill method (OR=1.27; 95% CI, 1.06, 1.53). CONCLUSIONS:We suggest that overweight might increase the risk of lumbar diseases, and weight control should be considered for overweight or obese population to reduce the occurrence and development of lumbar disease.
10.1097/BSD.0000000000000235
Three-question depression screener used for lumbar disc herniations and spinal stenosis.
Levy Howard I,Hanscom Brett,Boden Scott D
Spine
STUDY DESIGN:A depression screener was used to determine positive responses amongst patients with two disorders commonly treated with surgery. OBJECTIVE:To examine the relation between positive responses to the depression screener and pain characteristics, sociodemographic responses, and Short-Form 36-Item Health Survey subscale scores among patients with lumbar disc herniation or spinal stenosis. SUMMARY OF BACKGROUND DATA:Numerous studies have reported a correlation between depression and low back pain, but few have examined this relation among patients with a diagnosis of sciatica from lumbar disc herniation or spinal stenosis. The Health Status Questionnaire 2.0 includes both the Short-Form 36-Item Health Survey (a validated, multidimensional, generic instrument measuring health-related quality of life and functional status) and the three-question depression screener. METHODS:The database of the National Spine Network (a nonprofit collaboration of physicians caring for patients with back and neck problems that pools patient data) was queried for patients 18 to 65 years of age with a diagnosis of lumbar disc herniation (n = 2878) and patients 30 to 80 years of age with a diagnosis of spinal stenosis (n = 3801). Depression screeners scored positive when patients reported depressive symptoms within the year to any question about symptoms. RESULTS:The screener elicited positive responses from 36.4% of the patients with spinal stenosis and 38.4% of the patients with lumbar disc herniation. Among the patients with spinal stenosis or lumbar disc herniation, those with positive depression screener responses reported longer duration of symptoms (>7 weeks) and failure to improve. They were more likely to be obese, recipients of workers' compensation, unmarried, and less educated (below Grade 12). In multivariate analyses, positive depression screener responses were significantly associated with an attorney's services and a longer duration of symptoms. CONCLUSIONS:A positive depression screener response is strongly associated with poorer functional status and health-related quality of life, as measured by the Short-Form 36-Item Health Survey, among patients with lumbar disc herniation or spinal stenosis, and higher symptom intensity.
Immuohistochemical score of matrix metalloproteinase-1 may indicate the severity of symptomatic cervical and lumbar disc degeneration.
Hsu Hsien-Ta,Yue Chung-Tai,Teng Ming-Sheng,Tzeng I-Shiang,Li Tin-Chou,Tai Po-An,Huang Kuo-Feng,Chen Cheng-Yu,Ko Yu-Lin
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:Intervertebral disc (IVD) degeneration is related to numerous risk factors, including obesity. Leptin, one of the commonly measured adipokines, is proven to play an important role in the pathogenesis of IVD degeneration. In the context of IVD degeneration, matrix metalloproteinase-1 (MMP-1), which is upregulated and activated by leptin, is the most abundant catabolic enzyme. It remains unclear which of the factors mentioned above is most strongly associated with IVD degeneration. PURPOSE:To investigate the influence of MMP-1 in IVD degeneration, we determined the strength of different predictors, including age, sex, magnetic resonance imaging (MRI), Modic changes (MCs), body mass index (BMI), leptin, and MMP-1. This was achieved by assessing the correlation among these factors and histologic degeneration score (HDS). STUDY DESIGN:This study included 89 patients undergoing cervical discectomy for disc herniation, 93 who underwent lumbar discectomy, and 90 control subjects. Herniated disc tissue and plasma were used after the study was approved by the Human Ethics Review Committee at the authors' institution. METHODS:Hematoxylin and eosin (H&E), Alcian blue-PAS and immunohistochemical (IHC) staining were performed to measure the expression levels of leptin and MMP-1. Circulating plasma levels of leptin and MMP-1 were measured using an enzyme-linked immunosorbent assay. To assess the correlation with HDS, measurements of age, sex, BMI, MRI scale, MCs scale, leptin/MMP-1 plasma concentration, and leptin/MMP-1 IHC expression were analyzed. RESULTS:Patients with cervical or lumbar discectomy had significantly higher BMI than controls. Significantly more men than women were involved in the lumbar patients as compared with the cervical patients and the control subjects. After adjustment for age and sex, plasma leptin and leptin IHC score correlated significantly with BMI in patients with cervical or lumbar discectomy. Age, sex, MRI scale, MCs scale, and leptin/MMP-1 plasma concentration were not positively correlated with HDS. HDS was significantly associated with BMI, leptin IHC score, and MMP-1 IHC score. After a stepwise-multiple linear regression analysis to evaluate the strength of the correlations between HDS and various factors, only the MMP-1 IHC score demonstrated an independent association with HDS in patients with degeneration of the cervical or lumbar disc. CONCLUSIONS:MMP-1 IHC score is an independent predictor of the severity of cervical or lumbar IVD degeneration. CLINICAL SIGNIFICANCE:MMP-1 IHC score may be used as an indicator of IVD degeneration.
10.1016/j.spinee.2019.08.004
Challenging the cumulative injury model: positive effects of greater body mass on disc degeneration.
Videman Tapio,Gibbons Laura E,Kaprio Jaakko,Battié Michele C
The spine journal : official journal of the North American Spine Society
BACKGROUND CONTEXT:There are differing views as to the causes of disc degeneration. One view, referred to as a cumulative or repetitive injury model, explains disc degeneration, in great part, as the result of "wear and tear" on the disc from routine daily exposures to physical loading or biomechanical forces. Perhaps paradoxically, such physical loading has been thought to be generally beneficial for other structures of the musculoskeletal system. PURPOSE:The goal of this study was to investigate the associations of physical loading from body weight using quantitative measures of disc degeneration. STUDY DESIGN:This is an exposure-discordant twin study. METHODS:We selected 44 pairs of healthy male monozygotic (MZ) twins with 8 kg or more discordance in body weight (mean 13 kg), with lumbar magnetic resonance imaging and bone density measurements available. The main outcome of disc degeneration was assessed through quantitatively measured disc height, and disc signal intensity and signal variation adjusted by the intrabody reference, adjacent cerebrospinal fluid signal, at L1-L4. Data on suspected constitutional and environmental risk factors were available for control of possible confounding factors. RESULTS:Higher body weight was associated with 6.2% higher bone density in the lumbar spine, confirming an effective discordance (p<.0001). Disc signal variation was 5.4% higher ("better") among the heavier MZ co-twins (p=.005), but the 2.6% higher disc heights and 2.9% higher adjusted disc signals were not statistically significant. CONCLUSIONS:Contrary to common beliefs, our findings suggest that cumulative or repetitive loading because of higher body mass (nearly 30 pounds on average) was not harmful to the discs. In fact, a slight delay in L1-L4 disc desiccation was observed in the heavier men, as compared with their lighter twin brothers.
10.1016/j.spinee.2009.10.005
A preliminary association study of fat mass and obesity associated gene polymorphisms and degenerative disc disease in a Chinese Han population.
Lao Lifeng,Zhong Guibin,Li Xinfeng,Liu Zude
The Journal of international medical research
OBJECTIVE:To assess whether polymorphisms of the fat mass and obesity associated gene (FTO) are associated with the presence and severity of degenerative disc disease (DDD) in a Chinese Han population. METHODS:In this case-control study, patients with DDD and controls matched for age, sex and body mass index were genotyped for six single nucleotide polymorphisms (SNPs) of FTO. Disease severity was measured using the Japanese Orthopaedic Association score. Allelic, genotypic and genotype-phenotype association analyses were performed. RESULTS:A total of 80 patients with DDD and 80 controls were studied. All six SNPs were in Hardy-Weinberg equilibrium. The frequencies of allele G and genotype G/G of the SNP rs11076008 were significantly associated with DDD after Bonferroni correction. No associations were shown between the SNPs studied and sex or disease severity. CONCLUSION:The SNP rs11076008 of FTO may play an important role in the development of DDD in a Chinese Han population. The G/G genotype and/or G allele may be a risk factor for DDD. These results suggest that FTO is a DDD predisposition gene and may support a close relationship between obesity and DDD.
10.1177/0300060513503761
Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients.
Urrutia Julio,Besa Pablo,Lobos Daniel,Campos Mauricio,Arrieta Cristobal,Andia Marcelo,Uribe Sergio
Skeletal radiology
PURPOSE:To determine the association of paraspinal muscles and psoas relative cross-sectional area (RCSA) and fat signal fraction (FSF) with sex, age, and intervertebral disc degeneration (IDD) in symptomatic patients. METHODS:We retrospectively evaluated 80 adult patients with spinal symptoms using T2-weighted magnetic resonance images. We determined RCSA and FSF of the paraspinal muscles (erector spinae and multifidus) and psoas from L1-L2 to L5-S1; we determined IDD using the Pfirrmann classification. We compared differences in muscle RCSA and FSF based on sex and IDD, and we correlated age and IDD with RCSA and FSF. Using multivariate linear regression analyses, we determined the impact of sex, age, and IDD on RCSA and FSF. RESULTS:Men exhibited larger psoas RCSA but not larger paraspinal muscles RCSA than women. Women had larger FSF in the paraspinal muscles and psoas. Increasing IDD was associated with larger FSF if ≥2 Pfirrmann grades were observed. IDD correlated with FSF of the paraspinal muscles, and age correlated with FSF of the paraspinal muscles and psoas. IDD was less consistently correlated with RCSA, but age correlated negatively with RCSA of all three muscles. Linear regression analyses demonstrated that sex, age, and IDD were each independently associated with FSF of the paraspinal muscles; additionally, sex and age, but not IDD, were associated with psoas FSF. RCSA was less consistently influenced by these three variables. CONCLUSIONS:Sex, age, and IDD are independently associated with paraspinal muscles FSF; only sex and age influence psoas FSF.
10.1007/s00256-018-2880-1
Heritability of lumbar flexibility and the role of disc degeneration and body weight.
Battié Michele C,Levalahti Esko,Videman Tapio,Burton Kim,Kaprio Jaakko
Journal of applied physiology (Bethesda, Md. : 1985)
Spinal range of motion is evaluated in assessing patients with back problems and monitoring outcomes, as well as in general fitness assessments. Yet, determinants of the substantial interindividual variation in spinal range of motion are not well understood. Substantial genetic effects on global measures of range of motion and hypermobility have been suggested from earlier studies, but genetic influences specifically on spinal range of motion have not been previously studied. The objectives of the present study were to investigate the relative role of genetic and environmental influences on lumbar range of motion in adult men and the pathways through which genes may influence range of motion. Thus we conducted a classic twin study of 300 monozygotic and dizygotic male twin pairs with consideration of covariates, using standard statistical methods. All subjects underwent a clinical examination, including general anthropometrics, lumbar range of motion, and lumbar MRI to assess disc degeneration, as well as an extensive interview on environmental and behavioral exposures and back pain history. We found the proportion of variance in lumbar range of motion attributable to genetic influences (heritability estimate) to be 47%. The extent of lumbar range of motion in flexion was predominantly determined by genetic influences (64%), while extension was influenced to a somewhat greater degree by environmental and behavioral factors. Statistically significant age-adjusted genetic correlations were found between lumbar extension and disc degeneration variables (r(a) = -0.38 to -0.43) and between flexion and body weight (r(a) = -0.33), suggesting two pathways through which genes influence lumbar range of motion.
10.1152/japplphysiol.01009.2007
High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults.
Brady Sharmayne R E,Urquhart Donna M,Hussain Sultana Monira,Teichtahl Andrew,Wang Yuanyuan,Wluka Anita E,Cicuttini Flavia
Arthritis research & therapy
OBJECTIVES:Low back pain is the largest contributor to disability worldwide. The role of body composition as a risk factor for back pain remains unclear. Our aim was to examine the relationship between fat mass and fat distribution on back pain intensity and disability using validated tools over 3 years. METHODS:Participants (aged 25-60 years) were assessed at baseline using dual-energy X-ray absorptiometry (DXA) to measure body composition. All participants completed the Chronic Pain Grade Scale at baseline and 3-year follow-up. Of the 150 participants, 123 (82%) completed the follow-up. RESULTS:Higher baseline body mass index (BMI) and fat mass (total, trunk, upper limb, lower limb, android, and gynoid) were all associated with high intensity back pain at either baseline and/or follow-up (total fat mass: multivariable OR 1.05, 95% CI 1.01-1.09, p < 0.001). There were similar findings for all fat mass measures and high levels of back disability. A higher android to gynoid ratio was associated with high intensity back pain (multivariable OR 1.04, 95% CI 1.01-1.08, p = 0.009). There were no associations between lean mass and back pain. CONCLUSIONS:This cohort study provides evidence for the important role of fat mass, specifically android fat relative to gynoid fat, on back pain and disability.
10.1186/s13075-019-1953-4
[Imaging study of lumbosacral multifidus muscle fat changes in patients with lumbar disc herniation].
Hu Ling-San,Zhao Ye,Zhang Cheng-Zhe,Zhang Min,Zhan Hong-Sheng,Yuan Wei-An
Zhongguo gu shang = China journal of orthopaedics and traumatology
OBJECTIVE:To compare the degeneration of lumbosacral multifidus muscle in patients with lumbar disc herniation. METHODS:Magnetic Resonance Spectroscopy was performed on the multifidus muscle of 35 healthy volunteers and 35 patients with unilateral L lumbar disc herniation. There were 20 males and 15 females in each group, aged from 25 to 55 years old. In healthy volunteers, the mean age was (35.66±8.73) years old and the BMI was (21.85±1.94) kg/m; in the patients, the mean age was (36.09±7.70) years old, the BMI was (21.50±1.78) kg/m, the VAS score was (4.40±0.88) points, the course of disease was (11.2±7.14) months. The proportion of fat in the L lumbosacral multifidus muscle and the proportion of fat-suppressed cross-sectional area were observed by MRI, the differences of the observation indexes of the two groups were compared through data analysis. RESULTS:In healthy volunteers, the proportion of fat on the left side of the multifidus muscle was (0.169± 0.035)%, the proportion of fat removal cross-sectional area on the left side of the multifidus muscle was (0.699±0.070)%, the proportion of fat on the right side of the multifidus muscle was (0.168±0.031)%, and the proportion of fat removal cross-sectional area on the right side of the multifidus muscle was (0.712±0.056)%, there was no significant difference between the two sides (>0.05). In patients, the proportion of fat on the healthy side of multifidus muscles was (0.173±0.021)%, the proportion of fat removal cross-sectional area on the healthy side of multifidus muscles was (0.695±0.054)%, the proportion of fat on the affected side of the multifidus muscle was (0.228±0.027)%, and the proportion of fat removal cross-sectional area on the affected side of the multifidus muscle was (0.629±0.048)%, the differences of the above indexes on both sides were statistically significant (<0.05). There was a statistically significant difference in the proportion of multifidus muscle fat and the ratio of fat-suppressed cross-sectional area between the affected side and volunteers (<0.05). There was no significant difference in fat ratio and fat-suppressed cross sectional area ratio between the left and right sides of healthy volunteers and healthy side of patients (>0.05). CONCLUSION:There is degeneration of lumbosacral multifidus muscle on the affected side of patients with unilateral L intervertebral disc herniation, featuring multifidus muscular atrophy and fat infiltration.
10.12200/j.issn.1003-0034.2020.02.016
Gender differences in multifidus fatty infiltration, sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis.
Chua Michelle,Hochberg Uri,Regev Gilad,Ophir Dror,Salame Khalil,Lidar Zvi,Khashan Morsi
The spine journal : official journal of the North American Spine Society
BACKGROUND:In patients with lumbar spinal stenosis, female gender has been associated with higher pain and functional disability. Sarcopenia and multifidus atrophy have also been associated with symptomatic severity. PURPOSE:The purpose of this study was to determine if gender differences in sarcopenia and multifidus atrophy are associated with gender disparities in disease symptomatology. STUDY DESIGN:Prospectively collected medical records and imaging studies were retrospectively reviewed. PATIENT SAMPLE:We retrospectively reviewed medical records and imaging studies for 63 patients with clinically and radiologically defined lumbar spinal stenosis at L3/4 or L4/5 who underwent minimally invasive decompression. OUTCOME MEASURES:Pain and functional disability were measured using the Oswestry Disability Index (ODI) and visual analogue scores for back pain (VASB) and leg pain (VASL). METHODS:Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify gender linked and gender independent predictors of higher ODI, VASB, and VASL. RESULTS:Female gender was significantly associated with lower multifidus fnCSA (p < .001), higher multifidus FI (p < .001), lower psoas tCSA (p < .001), lower psoas rCSA (p = .002), and higher preoperative ODI (p = .008). Lower psoas rCSA (p = .044) and psoas tCSA in the lowest sex specific quartile (p = .034) were significantly associated with higher preoperative VASB and psoas rCSA less than the sex specific median (p = .050) was significantly associated with higher preoperative VASL after controlling for age and gender. Multifidus FI was significantly associated with preoperative ODI after adjusting for age (p = .048) but not after controlling additionally for gender (p = .651). CONCLUSIONS:Female patients with lumbar spinal stenosis may develop more severe and functionally significant multifidus atrophy, resulting in a more severe clinical course with higher functional disability. Sarcopenia was significantly associated with higher preoperative back pain and leg pain in both male and female patients with lumbar spinal stenosis.
10.1016/j.spinee.2021.06.007
Causal Associations of Obesity With the Intervertebral Degeneration, Low Back Pain, and Sciatica: A Two-Sample Mendelian Randomization Study.
Zhou Jingzhu,Mi Jiarui,Peng Yu,Han Huirong,Liu Zhengye
Frontiers in endocrinology
The role of obesity in the development of dorsopathies is still unclear. In this study, we assessed the associations between body mass index (BMI) and several dorsopathies including intervertebral disc degeneration (IVDD), low back pain (LBP), and sciatica by using the Mendelian randomization method. We also assessed the effect of several obesity-related traits on the same outcomes. Single-nucleotide polymorphisms associated with the exposures are extracted from summary-level datasets of previously published genome-wide association studies. Summary-level results of IVDD, LBP, and sciatica were from FinnGen. In our univariable Mendelian randomization analysis, BMI is significantly associated with increased risks of all dorsopathies including sciatica (OR = 1.33, 95% CI, 1.21-1.47, p = 5.19 × 10), LBP (OR = 1.28, 95% CI, 1.18-1.39, p = 6.60 × 10), and IVDD (OR = 1.23, 95% CI, 1.14-1.32, p = 2.48 × 10). Waist circumference, hip circumference, whole-body fat mass, fat-free mass, and fat percentage, but not waist-hip ratio, were causally associated with increased risks of IVDD and sciatica. Higher hip circumference, whole-body fat mass, fat-free mass, and fat percentage increased the risk of LBP. However, only whole-body fat-free mass remained to have a significant association with the risk of IVDD after adjusting for BMI with an odds ratio of 1.57 (95% CI, 1.32-1.86, p = 2.47 × 10). Proportions of BMI's effect on IVDD, sciatica, and LBP mediated by leisure sedentary behavior were 41.4% (95% CI, 21.8%, 64.8%), 33.8% (95% CI, 17.5%, 53.4%), and 49.7% (95% CI, 29.4%, 73.5%), respectively. This study provides evidence that high BMI has causal associations with risks of various dorsopathies. Weight control is a good measure to prevent the development of dorsopathies, especially in the obese population.
10.3389/fendo.2021.740200
Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins.
Dario Amabile B,Ferreira Manuela L,Refshauge Kathryn,Sánchez-Romera Juan F,Luque-Suarez Alejandro,Hopper John L,Ordoñana Juan R,Ferreira Paulo H
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:To investigate the relationship between different measures of obesity and chronic low back pain (LBP) using a within-pair twin case-control design that adjusts for genetics and early shared environment. METHODS:A cross-sectional association between lifetime prevalence of chronic LBP and different measures of obesity (body mass index-BMI; percent body fat; waist circumference; waist-hip ratio) was investigated in 1128 female twins in three stages: (i) total sample analysis; (ii) within-pair case-control analysis for monozygotic (MZ) and dizygotic (DZ) twins together; (iii) within-pair case-control analysis separated by DZ and MZ. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS:BMI (OR 1.12; 95% CI 1.02-1.26) and percent body fat (OR 1.15; 95% CI 1.01-1.32) were weakly associated with lifetime prevalence of chronic LBP in the total sample analysis but were absent when shared environment and genetic factors were adjusted for using the within-pair case-control analysis. Greater waist-hip ratios were associated with smaller prevalence estimates of chronic LBP in the within-pair case-control analysis with both MZ and DZ twins (OR 0.67; 95% CI 0.47-0.94). However, this association did not remain after the full adjustment for genetic factors in the MZ within-pair case-control analysis. CONCLUSIONS:BMI, percent of fat mass and greater depositions of fat and mass around the hips are associated with increases in chronic LBP prevalence in women but these associations are small and appear to be confounded by the effects of genetics and early shared environment. Therefore, our results do not support a causal direct relationship between obesity and chronic LBP.
10.1007/s00586-015-4055-2
Effect of race, age, and gender on lumbar muscle volume and fat infiltration in the degenerative spine.
Hida Tetsuro,Eastlack Robert K,Kanemura Tokumi,Mundis Gregory M,Imagama Shiro,Akbarnia Behrooz A
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
BACKGROUND:The quantity and quality of spinal muscles in patients with degenerative spinal diseases and various backgrounds such as age, gender, or race is unclear. We quantitatively evaluated the cross-sectional area (CSA) and fatty degeneration of the muscles around the spine, using magnetic resonance imaging (MRI) in patients with degenerative spinal disease, and studied the effects of age, gender, and race in multicenter retrospective study. METHODS:The subjects were Caucasian and Asian patients with degenerative lumbar disease who underwent L4-5 single level spinal fusion surgery at centers in the United States and Japan. Using preoperative axial T2 MRI at the L4-5 disc level, the cross-sectional areas of the psoas and paraspinal muscles were measured. Fat infiltration was measured using the threshold method, and percent fat area (%FA) was calculated for each muscle. The muscle/disc area ratio (MDAR) was used to control for size differences per patient. T-test, Pearson's correlation coefficient, partial correlation, and multiple linear regression were used for statistical analysis. RESULTS:In total, 140 patients (53 men; 87 women; mean age, 69.2 years) were analyzed. Age was similar in Caucasians (n = 64) and Asians (n = 76). MDARs were larger in Caucasians for paraspinal and psoas muscles (p < 0.005). Percent FA of psoas was similar in Caucasians and Asians, but greater in the paraspinal muscles of Asians (p < 0.05). After controlling for race and gender, age was correlated negatively with MDAR (p < 0.001) and positively with %FA (p < 0.001). In the multiple linear regression analysis, age, gender, and race were independently affected by MDAR and %FA. CONCLUSIONS:Lumbar muscle mass and quality were affected by age, gender, and race, independently, in patients with degenerative lumbar disease.
10.1016/j.jos.2019.09.006
Comparison of metabolic risk factors, physical performances, and prevalence of low back pain among categories determined by visceral adipose tissue and trunk skeletal muscle mass in middle-aged men.
Tanaka Noriko I,Maeda Hisashi,Tomita Aya,Suwa Masataka,Imoto Takayuki,Akima Hiroshi
Experimental gerontology
The present study compared metabolic risk factors, physical performances, and musculoskeletal impairment among categories determined by visceral adipose tissue (VAT) and trunk skeletal muscle (SM) mass in middle-aged Japanese men. In total, 1026 healthy Japanese males aged between 35 and 59 years were categorized into 4 groups according to the amount of VAT and SM in the trunk measured using low-dose computed tomography (LowVAT-HighSM, LowVAT-LowSM, HighVAT-HighSM, and HighVAT-LowSM). Height, body mass waist circumference, body fat, intramuscular adipose tissue (IntraMAT), subcutaneous adipose tissue, biochemical blood profiles (triglycerides, high-density lipoprotein cholesterol, fasting blood glucose, aspartate transaminase, alanine transaminase and γ-glutamyl trans peptidase), physical performances (trunk flexibility, the chair-stand test, two-step length and hand-grip strength), the prevalence of low back pain, and lifestyle habits for exercise, alcohol intake and smoking, were compared among the groups. The results showed that LowVAT-HighSM had significantly superior biochemical blood profiles and physical performances to the other groups. HighVAT-LowSM had significantly higher %IntraMAT and the prevalence of low back pain. The two-step length, which is an index of walking ability, significantly differed according to the four subject categories. These results indicate that metabolic risk factors, physical performances, and prevalence of low back pain in middle-aged Japanese men may differ among four categories determined by VAT and trunk SM.
10.1016/j.exger.2021.111554
Geography of Lumbar Paravertebral Muscle Fatty Infiltration: The Influence of Demographics, Low Back Pain, and Disability.
Crawford Rebecca J,Volken Thomas,Ni Mhuiris Áine,Bow Cora C,Elliott James M,Hoggarth Mark A,Samartzis Dino
Spine
STUDY DESIGN:Cross-sectional. OBJECTIVE:We quantified fatty infiltration (FI) geography of the lumbar spine to identify whether demographics, temporal low back pain (LBP), and disability influence FI patterns. SUMMARY OF BACKGROUND DATA:Lumbar paravertebral muscle FI has been associated with age, sex, LBP, and disability; yet, FI accumulation patterns are inadequately described to optimize interventions. METHODS:This cross-sectional study employed lumbar axial T1-weighted magnetic resonance imaging in 107 Southern-Chinese adults (54 females, 53 males). Single-slices at the vertebral inferior end-plate per lumbar level were measured for quartiled-FI, and analyzed against demographics, LBP, and disability (Oswestry Disability Index). RESULTS:Mean FI% was higher in females, on the right, increased per level caudally, and from medial to lateral in men (P < 0.05). FI linearly increased with age for both sexes (P < 0.01) and was notably higher at L 4&5 than L1, 2&3 for cases aged 40 to 65 years. BMI and FI were unrelated in females and inversely in males (P < 0.001). Females with LBPweek and males with LBPyear had 1.7% (each) less average FI (P < 0.05) than those without pain at that time-point. Men locating their LBP in the back had less FI than those without pain (P < 0.001). Disability was unrelated to FI for both sexes (P > 0.05). CONCLUSION:Lumbar paravertebral muscle FI predominates in the lower lumbar spine, notably for those aged 40 to 65, and depends more on sagittal than transverse distribution. Higher FI in females and differences of mean FI between sexes for BMI, LBP, and disabling Oswestry Disability Index suggest sex-differential accumulation patterns. Our study contradicts pain models rationalizing lumbar muscle FI and may reflect a normative sex-dependent feature of the natural history of lumbar paravertebral muscles. LEVEL OF EVIDENCE:2.
10.1097/BRS.0000000000003060
Risk factors and association of body composition components for lumbar disc herniation in Northwest, Mexico.
Scientific reports
The goal of this study was to investigate the association of body composition components and to elucidate whether any of these components is a risk factor for Lumbar Disc Herniation (LDH). The group of study consisted of 90 adults involved in a physical activity program due to overweight and obesity. 19 adults with medical diagnostic through Magnetic Resonance Imaging with LDH. Body composition data was obtained with a bioelectrical impedance analyzer. Descriptive statistics and principal components analysis permitted to analyze the information's structure and to visualize information clusters. A logistic regression analysis allowed us to find the association between some of the variables of body composition with LDH. The Degree of Obesity, Body Mass Index, Visceral Fat Area and the Abdominal Circumference resulted associated (P values of 0.0388, 0.0171, 0.0055 and 0.0032, respectively). The application of Odd Ratio allowed us to declare the Visceral Fat Area and Abdominal Circumference as risk factors to develop Lumbar Disk Herniation. Our results provide a new record for future studies, and support for prescription of physical activity and changes in diet, to correct or prevent the development of LDH in the population of Baja California.
10.1038/s41598-020-75540-5