Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2019 | Scoliosis | Research article

Correlation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra

Authors: Xiang-Yao Sun, Chao Kong, Tong-Tong Zhang, Shi-Bao Lu, Wei Wang, Si-Yuan Sun, Ma-Chao Guo, Jun-Zhe Ding

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

Abstract

Background

There were several reports describing the biomechanics and microstructure of multifidus muscles in patients with lumbar disc herniation. However, correlations between lumbar multifidus muscle atrophy (LMA), spinopelvic parameters, and severity of adult degenerative scoliosis (ADS) have not been investigated. The study evaluated the impact of LMA and spinopelvic parameters on the severity of ADS.

Methods

One hundred and thirty-two patients with ADS were retrospectively reviewed. Standing whole-spine X-ray was used to evaluate the coronal (coronal Cobb angle, CA; coronal vertical axis, CVA) and sagittal (sagittal vertical axis, SVA; thoracic kyphosis, TK; lumbar lordosis, LL; pelvic incidence, PI; pelvic tilt, PT; sacral slope, SS) parameters. LMA was evaluated on axial T2-weighted magnetic resonance imaging (MRI) at intervertebral levels above and below the vertebra at the apex of the scoliotic curve. Clinical symptoms were evaluated by the Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) score. Multiple linear regression was used to assess correlations between LMA, spinopelvic parameters, and severity of scoliosis.

Results

LL and PT were negatively correlated with CA (P < 0.001); LL was positively correlated with SVA (P < 0.001). PI was positively correlated with CA (P < 0.001) and CVA (P < 0.001). PT (P < 0.001) and SS (P < 0.001) were negatively correlated with CVA. SS was negatively correlated with SVA (P < 0.001). Concave LMA at the upper or lower intervertebral level of the apical vertebra was positively correlated with CA (P ≤ 0.001); convex LMA at the upper or lower intervertebral level was negatively correlated with CA (P < 0.001). Convex LMA at the upper intervertebral level and concave LMA at the lower intervertebral level of the apical vertebra were negatively correlated with the SVA (P ≤ 0.001). At the upper intervertebral level, LMA on the concave side was positively correlated with CVA (P = 0.028); LMA on the convex side was negatively correlated with CVA (P = 0.012). PI was positively correlated with ODI (P < 0.001); PT (P < 0.001) and SS (P < 0.001) were negatively correlated with ODI. At the lower intervertebral level, LMA on the concave side was positively correlated with ODI (P = 0.038); LMA on the convex side was negatively correlated with ODI (P = 0.011). PI was positively correlated with JOA (P < 0.001); PT (P < 0.001) and SS (P < 0.001) were negatively correlated with JOA.

Conclusions

Spinopelvic parameters are correlated with the severity of ADS. Asymmetric LMA at both upper and lower intervertebral levels of the apical vertebra is positively correlated with CA. LMA on the diagonal through the apical vertebra is very important to maintain sagittal imbalance via parallelogram effect. LMA at lower intervertebral levels of the apical vertebra may have a predictive effect on ODI. JOA score seems to be more correlated with spinopelvic parameters than LMA.

Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976). 2002;27(4):387–92.CrossRef

Jimbo S, Kobayashi T, Aono K, et al. Epidemiology of degenerative lumbar scoliosis: a community-based cohort study. Spine (Phila Pa 1976). 2012;37(20):1763–70. https://doi.org/10.1097/BRS.0b013e3182575eaa.CrossRef

Yang C, Yang M, Chen Y, et al. Radiographic parameters in adult degenerative scoliosis and different parameters between sagittal balanced and imbalanced ADS patients. Medicine (Baltimore). 2015;94(29):e1198. https://doi.org/10.1097/MD.0000000000001198.CrossRef

Yoshihara K, Shirai Y, Nakayama Y, et al. Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976). 2011;26(6):622–6.CrossRef

Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2(2):142–6, 1-167. https://doi.org/10.1016/j.pmrj.2009.11.006.CrossRefPubMed

Lee JC, Cha JG, Kim Y, et al. Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine (Phila Pa 1976). 2008;33(3):318–25. https://doi.org/10.1097/BRS.0b013e318162458f.CrossRef

Yagi M, Hosogane N, Watanabe K, et al. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J. 2016;16(4):451–8. https://doi.org/10.1016/j.spinee.2015.07.001.CrossRefPubMed

Battaglia PJ, Maeda Y, Welk A, et al. Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manip Physiol Ther. 2014;37(3):190–7. https://doi.org/10.1016/j.jmpt.2013.12.010.CrossRef

Macintosh JE, Valencia F, Bogduk N, et al. The morphology of the human lumbar multifidus. Clin Biomech (Bristol, Avon). 1986;1(4):196–204. https://doi.org/10.1016/0268-0033(86)90146-4.CrossRef

10.

Wong E, Altaf F, Oh LJ, et al. Adult degenerative lumbar scoliosis. Orthopedics. 2017;40(6):e930–9. https://doi.org/10.3928/01477447-20170606-02.CrossRefPubMed

11.

Hodges P, Holm AK, Hansson T, et al. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976). 2006;31(25):2926–33. https://doi.org/10.1097/01.brs.0000248453.51165.0b.CrossRef

12.

Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2–10. https://doi.org/10.1054/math.1995.0243.CrossRefPubMed

13.

Bakou S, Cherel Y, Gabinaud B, et al. Type-specific changes in fibre size and satellite cell activation following muscle denervation in two strains of turkey (Meleagris gallopavo). J Anat. 1996;188(Pt 3):677–91.PubMedPubMedCentral

14.

Bishop DL, Milton RL. The effects of denervation location on fiber type mix in self-reinnervated mouse soleus muscles. Exp Neurol. 1997;147(1):151–8. https://doi.org/10.1006/exnr.1997.6605.CrossRefPubMed

15.

Herbison GJ, Jaweed MM, Ditunno JF. Muscle atrophy in rats following denervation, casting, inflammation, and tenotomy. Arch Phys Med Rehabil. 1979;60(9):401–4.PubMed

16.

Weber BR, Grob D, Dvorak J, et al. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine (Phila Pa 1976). 1997;22(15):1765–72.CrossRef

17.

Sun D, Liu P, Cheng J, et al. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation. BMC Musculoskelet Disord. 2017;18(1):167. https://doi.org/10.1186/s12891-017-1522-4.CrossRefPubMedPubMedCentral

18.

Macintosh JE, Bogduk N. The biomechanics of the lumbar multifidus. Clin Biomech (Bristol, Avon). 1989;1(4):205–13. https://doi.org/10.1016/0268-0033(86)90147-6.CrossRef

19.

Kim H, Lee CK, Yeom JS, et al. Asymmetry of the cross-sectional area of paravertebral and psoas muscle in patients with degenerative scoliosis. Eur Spine J. 2013;22(6):1332–8. https://doi.org/10.1007/s00586-013-2740-6.CrossRefPubMedPubMedCentral

20.

Fu X, Sun XL, Harris JA, et al. Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis. BMJ Open. 2016;6(11):e12103. https://doi.org/10.1136/bmjopen-2016-012103.CrossRef

21.

Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9. https://doi.org/10.1053/crad.1999.0340.CrossRefPubMed

22.

Weisz G, Houang M. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005;30(13):1558–9 1559.CrossRef

23.

Hong JY, Suh SW, Modi HN, et al. The prevalence and radiological findings in 1347 elderly patients with scoliosis. J Bone Joint Surg Br. 2010;92(7):980–3. https://doi.org/10.1302/0301-620X.92B7.23331.CrossRefPubMed

24.

Cho KJ, Suk SI, Park SR, et al. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2010;35(17):1595–601. https://doi.org/10.1097/BRS.0b013e3181bdad89.CrossRef

25.

Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10(4):314–9.CrossRefPubMedPubMedCentral

26.

Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2015;30(3):346–53.CrossRef

27.

Hawasli AH, Chang J, Yarbrough CK, et al. Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis. Spine J. 2016;16(9):1070–8. https://doi.org/10.1016/j.spinee.2016.04.017.CrossRefPubMedPubMedCentral

28.

Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082–5.CrossRef

29.

Mac-Thiong JM, Transfeldt EE, Mehbod AA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009;34(15):E519–27. https://doi.org/10.1097/BRS.0b013e3181a9c7ad.CrossRef

30.

Masuda K, Higashi T, Yamada K, et al. The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis. J Neurosurg Spine. 2018:1–6. https://doi.org/10.3171/2018.1.SPINE17879.PubMed

Title: Correlation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra
Authors: Xiang-Yao Sun
Chao Kong
Tong-Tong Zhang
Shi-Bao Lu
Wei Wang
Si-Yuan Sun
Ma-Chao Guo
Jun-Zhe Ding
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Scoliosis
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-019-1323-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Correlation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Arthroscopic management for early-stage tuberculosis of the ankle

Combined use of intravenous and topical tranexamic acid in patients aged over 70 years old undergoing total hip arthroplasty

Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials

Feasibility of iliosacral screw placement in patients with upper sacral dysplasia

Comparison of bilateral decompression via unilateral laminotomy and conventional laminectomy for single-level degenerative lumbar spinal stenosis regarding low back pain, functional outcome, and quality of life - A Randomized Controlled, Prospective Trial

The expression of Eps15 homology domain 1 is negatively correlated with disease-free survival and overall survival of osteosarcoma patients