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Cited by 116Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationCervical and Thoracic Myelopathy

Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology?

Battié, Michele C., Niemelainen, Riikka, Gibbons, Laura E., Dhillon, Sukhvinder·2012·The Spine Journal
DOI 10.1016/j.spinee.2012.08.020
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Abstract

Background context Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions.Purpose To investigate asymmetry in cross-sectional area (CSA) and fat infiltration in multifidus and other paraspinal muscles in patients with acute or subacute unilateral symptoms of radiculopathy and concordant posterolateral disc herniation. If multifidus asymmetry is indeed related to local pathology, this may serve as a marker for helping to target the search for less clearly identifiable pathology responsible for low back-related symptoms, which currently remains elusive in approximately 85% of those seeking care.Study design Cross-sectional observational study.Patient sample Subjects were patients referred to magnetic resonance imaging (MRI) with unilateral leg symptoms of less than 6 weeks onset suggestive of radiculopathy, with a consistent posterolateral lumbar disc herniation verified on imaging.Methods Using T2-weighted axial MRI, measurements were obtained for total muscle CSA and signal intensity, functional (fat-free) CSA, and the ratio of functional CSA to total CSA.Results Forty-three subjects met the inclusion criteria. The ratio of functional CSA to total muscle CSA was smaller on the side of the herniation than on the unaffected side, both below (mean 0.69 vs. 0.72, p=.007) and at the level of herniation (mean 0.78 vs. 0.80, p=.031). Multifidus signal intensity (fat infiltration) was greater on the side of the herniation at the level below the herniation (p=.014). Contrary to expectation, greater total multifidus CSA was found ipsilateral to the pathology at the level of herniation (p=.033). No asymmetries were found at the level above the herniation or in any other paraspinal muscles, with the exception of higher signal in the erector spinae at the level and side of herniation.Conclusions Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.

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  • Chronic low back pain can become a complex condition in its own right, with persistent central nervous system changes and structural changes in the back.

    “There is growing evidence that cLBP, like other chronic pain conditions, can progress beyond a symptomatic state to a complex condition unto itself,109 involving persistent anatomical and functional changes in the central nervous system9, 93, 100 in addition to structural changes in the back (e.g., degenerative spinal changes, atrophy or asymmetry of para-spinal muscles).10, 11, 14”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [11]

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Authors
Battié, M. C., Niemelainen, R., Gibbons, L. E., & Dhillon, S.
Affiliations
  • University of Alberta (CA)
  • University of Washington (US)
Corresponding author
Battié, Michele C.
ORCID
Venue
The Spine Journal
Publisher
Elsevier BV
Published
2012-10
Volume
12
Issue
10
Pages
932-939
ISSN
1529-9430 (ISSN-L)
DOI
10.1016/j.spinee.2012.08.020
OpenAlex
W2105011527
Cited by
116
References
26
Citations by year
2026: 6 · 2025: 6 · 2024: 6 · 2023: 9 · 2022: 17 · 2021: 9 · 2020: 8 · 2019: 11 · 2018: 13 · 2017: 4 · 2016: 10 · 2015: 5 · 2014: 10 · 2013: 2
FWCI
3.92
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Spine Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords
multifidus, lumbar disc herniation, radiculopathy, muscle fat infiltration, paraspinal muscles, erector spinae, low back pain, MRI signal intensity, diagnostic biomarkers, T2-weighted imaging
MeSH terms
Adult, Cross-Sectional Studies, Female, Humans, Intervertebral Disc, Intervertebral Disc Displacement, Lumbar Vertebrae, Magnetic Resonance Imaging, Male, Middle Aged, Muscular Atrophy, Spinal, Radiography, Muscle, Skeletal, Young Adult

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