Padwal Jennifer, Berry David B, Hubbard James C, Zlomislic Vinko, Allen R Todd, Garfin Steven R, Ward Samuel R, Shahidi Bahar
Departments of Medicine, University of California, San Diego, USA.
Departments of Nanoengineering, University of California, San Diego, USA.
BMC Musculoskelet Disord. 2020 Nov 20;21(1):764. doi: 10.1186/s12891-020-03791-4.
Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology.
In 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation.
No significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region.
The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.
由于多裂肌深层和浅层纤维的独特排列，它们在维持脊柱稳定性和腰椎姿势方面可能具有不同的作用；多裂肌浅层负责腰椎伸展，深层负责节段间稳定性。在慢性腰椎疾病患者中，已显示多裂肌深层而非浅层的肌肉激活模式减弱或延迟。这被解释为疼痛对深部区域的影响不同。然而，尚不清楚影响多裂肌组成和功能的退行性变化在浅层和深层区域是否存在差异，这是这些电生理变化的另一种解释。因此，本研究的目的是调查腰椎疾病患者多裂肌浅层和深层区域的宏观结构和微观结构差异。
对16例因退行性疾病接受腰椎手术的患者，在两个不同位置获取多裂肌活检样本：1）靠近棘突的肌肉最浅层部分；2）在棘突外侧约1厘米处且在受影响椎体水平的棘突间边界更深的位置。对这些浅层和深层区域之间与肌肉功能相关的结构特征进行组织学比较，包括组织组成、脂肪分数、纤维横截面积、纤维类型、再生、退变、血管化和炎症。
多裂肌浅层和深层区域在脂肪信号分数、肌肉面积、纤维横截面积、肌肉再生、肌肉退变或血管化方面未发现显著差异。两个区域的总胶原蛋白含量相同。然而，发现多裂肌浅层比深层含有更少的疏松胶原蛋白和更多的致密胶原蛋白。
我们的研究结果不支持腰椎疾病患者多裂肌深层退变更严重的观点，因为多裂肌浅层和深层区域的肌肉微观结构和宏观结构的总体退行性变化是相同的。在这些患者中，多裂肌未得到保护以维持脊柱的活动度和结构稳定性。
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