Suri Pradeep, Fry Adrielle L, Gellhorn Alfred C
Seattle Epidemiologic Research and Information Center (ERIC) Division of Rehabilitation Care Services, VA Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108; and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
PM R. 2015 Dec;7(12):1269-1281. doi: 10.1016/j.pmrj.2015.04.016. Epub 2015 May 5.
To determine whether lumbar muscle characteristics on magnetic resonance imaging (MRI) or computed tomography (CT) can inform clinicians as to the course of future low back pain (LBP), functional limitations, or physical performance, in adults with or without LBP. TYPE: Systematic review.
We searched PubMed, Embase, and CINAHL through October 2014 for articles published in English in which authors assessed lumbar muscle characteristics on conventional MRI/CT as predictors of future LBP, functional limitations, or physical performance in adults. Studies with only postsurgical subjects were excluded. Our search identified 3554 articles, of which 6 observational cohort studies were included in the final review.
We used the Newcastle Ottawa Scale to evaluate potential bias. Data were extracted on study design, study population, sample size, participant characteristics, details of MRI/CT assessments, interventions, study outcomes, analysis methods, and study results. Because of heterogeneity between studies, we conducted a qualitative evidence synthesis.
Among high-quality studies, there was limited evidence that, for individuals with or without LBP, greater MRI-detected multifidus cross-sectional area at L5-S1 predicted greater LBP intensity at 1-year follow-up, lesser erector spinae fat infiltration (FI) at L5-S1 predicted greater LBP intensity at 15-year follow-up, and greater erector spinae side-to-side FI asymmetry at L3-L4 predicted lower LBP frequency at 15-year follow-up; however, there was also limited evidence that all other MRI-detected paraspinal muscle characteristics examined were not predictive of LBP incidence, prevalence, frequency, or intensity at follow-up durations ranging from 1 to 15 years. There was limited evidence that greater CT-detected trunk muscle FI predicted worse physical performance in older adults at 3-year follow-up, but that trunk muscle cross-sectional area did not.
Few lumbar muscle characteristics have limited evidence for an association with future LBP and physical performance outcomes, and the vast majority have limited evidence for having no association with such outcomes.
确定在有或没有下腰痛（LBP）的成年人中，磁共振成像（MRI）或计算机断层扫描（CT）上的腰椎肌肉特征能否为临床医生提供有关未来下腰痛病程、功能受限或身体机能的信息。类型：系统评价。
我们检索了截至2014年10月的PubMed、Embase和CINAHL，查找以英文发表的文章，其中作者评估了常规MRI/CT上的腰椎肌肉特征，作为成年人未来下腰痛、功能受限或身体机能的预测指标。仅纳入术后受试者的研究被排除。我们的检索识别出3554篇文章，其中6项观察性队列研究纳入最终综述。
我们使用纽卡斯尔渥太华量表评估潜在偏倚。提取了关于研究设计、研究人群、样本量、参与者特征、MRI/CT评估细节、干预措施、研究结局、分析方法和研究结果的数据。由于研究之间存在异质性，我们进行了定性证据综合分析。
在高质量研究中，证据有限，对于有或没有下腰痛的个体，MRI检测到的L5-S1节段多裂肌横截面积越大，在1年随访时下腰痛强度越大；L5-S1节段竖脊肌脂肪浸润（FI）越少，在15年随访时下腰痛强度越大；L3-L4节段竖脊肌左右FI不对称性越大，在15年随访时下腰痛频率越低；然而，证据也有限，即所有其他MRI检测到的椎旁肌特征在1至15年的随访期间均不能预测下腰痛的发生率、患病率、频率或强度。证据有限，CT检测到的躯干肌FI越大，在3年随访时老年人的身体机能越差，但躯干肌横截面积则不然。
很少有腰椎肌肉特征有有限证据表明与未来下腰痛和身体机能结局有关联，而绝大多数特征有有限证据表明与这些结局无关联。
