Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
Spine J. 2019 May;19(5):862-868. doi: 10.1016/j.spinee.2018.12.004. Epub 2018 Dec 7.
The lumbar paraspinal muscles, including the erector spinae and multifidus, play an important role in movement and control of the spine. However, our understanding of their contribution to low back pain and disability is unclear. Systematic reviews have reported conflicting evidence for an association between paraspinal muscle size and low back pain, and a paucity of data examining muscle cross-sectional area (CSA) and low back disability.
To investigate the relationship between paraspinal muscle CSA and both low back pain intensity and disability.
STUDY DESIGN/SETTING: One-year longitudinal cohort study.
Participants were selected from the SpineData Registry (Denmark), which enrolls people with low back pain of 2 to 12 months duration without radiculopathy and a satisfactory response to primary intervention.
Current, typical, and worst pain in the prior 2 weeks were assessed by 11-point numeric rating scales and an average pain score was calculated, and disability was measured using the 23-item Roland-Morris Disability Questionnaire. CSA (cm) of the lumbar paraspinal muscles was measured at levels L3-L5 from magnetic resonance images.
Participants completed the study questionnaires and underwent the lumbar spine magnetic resonance images at baseline and were followed up 12 months later to repeat the questionnaires. Statistical analyses involved multivariable linear regression (cross-sectional analysis) and linear mixed-models (longitudinal analysis) with adjustment for confounders. Multiple imputation was conducted to account for missing data.
A total of 962 participants were included and 588 (65.8%) were followed up at 12-months. Multivariable analysis showed that greater paraspinal muscle CSA was associated with lower levels of disability, after adjusting for confounders (right mean CSA: baseline beta -0.16, 95% CI -0.26 to -0.06, p<.01; longitudinal beta -0.11, 95% CI -0.21 to -0.01, p=.03). This was evident at all levels, except L5 which was marginal at baseline (beta -0.08, 95% CI -0.15 to -0.001, p=.045) and not significant longitudinally (beta -0.05, 95% CI -0.12 to 0.02, p=.18). However, there were no associations between muscle CSA and pain intensity (baseline beta -0.02, 95% CI -0.06 to 0.02, p=.29; longitudinal beta -0.02, 95% CI -0.06 to 0.02, p=.34). Results were similar for both complete case and multiple imputation analyses.
This study found an inverse relationship between lumbar paraspinal muscle CSA and low back disability, but not pain intensity. While further investigation is needed, these findings suggest that treatment strategies directed at increasing paraspinal muscle size may be effective in reducing low back disability.
腰椎旁脊柱肌肉，包括竖脊肌和多裂肌，在脊柱运动和控制中起着重要作用。然而，我们对它们对腰痛和残疾的贡献的理解尚不清楚。系统评价报告称，脊柱旁肌肉大小与腰痛之间存在相互矛盾的证据，并且缺乏检查肌肉横截面积（CSA）与腰痛残疾之间关系的数据。
研究脊柱旁肌肉 CSA 与腰痛强度和残疾之间的关系。
研究设计/设置：为期一年的纵向队列研究。
参与者选自 SpineData 登记处（丹麦），该登记处招募腰痛持续 2 至 12 个月、无神经根病且对初级干预有满意反应的人群。
通过 11 点数字评分量表评估过去 2 周的当前、典型和最痛，并计算平均疼痛评分，使用 23 项 Roland-Morris 残疾问卷测量腰痛残疾。使用磁共振成像（MRI）在 L3-L5 水平测量腰椎旁脊柱肌肉的 CSA（cm）。
参与者完成研究问卷并在基线时接受腰椎 MRI 检查，并在 12 个月后进行随访以重复问卷。统计分析涉及多变量线性回归（横断面分析）和线性混合模型（纵向分析），并针对混杂因素进行调整。采用多重插补法处理缺失数据。
共纳入 962 名参与者，其中 588 名（65.8%）在 12 个月时进行了随访。多变量分析显示，在调整混杂因素后，脊柱旁肌肉 CSA 越大，残疾程度越低（右侧平均 CSA：基线β值为-0.16，95%CI 为-0.26 至-0.06，p<.01；纵向β值为-0.11，95%CI 为-0.21 至-0.01，p=.03）。这在所有水平都很明显，除了 L5 在基线时接近（β值为-0.08，95%CI 为-0.15 至-0.001，p=.045），纵向无显著意义（β值为-0.05，95%CI 为-0.12 至 0.02，p=.18）。然而，肌肉 CSA 与疼痛强度之间没有关联（基线β值为-0.02，95%CI 为-0.06 至 0.02，p=.29；纵向β值为-0.02，95%CI 为-0.06 至 0.02，p=.34）。完整病例和多重插补分析的结果相似。
本研究发现腰椎旁脊柱肌肉 CSA 与腰痛残疾呈负相关，但与疼痛强度无关。虽然需要进一步研究，但这些发现表明，旨在增加脊柱旁肌肉大小的治疗策略可能有助于降低腰痛残疾。
