Faculty of Rehabilitation Medicine, Department of Physiotherapy, Babol University of Medical Sciences, Babol, Iran.
Health Research Institute, Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran.
PLoS One. 2024 Apr 4;19(4):e0301726. doi: 10.1371/journal.pone.0301726. eCollection 2024.
Evaluation of spinal muscle morphology may be critical because of its impact on segmental stability and control of the lumbar spine in the subset of patients with clinical lumbar segmental instability (LSI). The purpose of this study was to compare lumbar muscle morphology in CNLBP patients with clinical LSI, CNLBP patients without clinical LSI.
This case-control study included 30 patients with CNLBP (15 with clinical LSI and 15 without clinical LSI) and 15 subjects without LBP. Axial magnetic resonance images from the L2 to S1 lumbar levels were used to evaluate the morphology of the lumbar muscles.
A significant increase in the muscle-to-fat infiltration index and a significant decrease in the relative muscle cross-sectional area (rmCSA) of the multifidus muscle at the L3-L4 to L5-S1 levels were observed in both CNLBP groups compared to the control group (p<0.05). The mean erector spinae mean rmCSA was significantly greater in the clinical LSI group compared to the control group (SMD = 0.853, 95% CI = 0.105 to -1.6, P = 0.044) and also compared to the CNLBP without clinical LSI (SMD = 0.894, 95% CI = -1.645 to -0.144, P = 0.030) at the L4-L5 level.
The atrophic changes of the multifidus muscle, in CNLBP patients with or without clinical LSI was observed. However, hypertrophic changes of the erector spinae muscle at the L4-L5 lumbar level were observed only in the clinical LSI group. Psaos major did not show significant atrophic or hypertrophic changes.
评估脊柱肌肉形态学可能至关重要，因为它会影响到有临床腰椎节段性不稳定（LSI）的患者亚群中腰椎节段的稳定性和控制。本研究的目的是比较有临床 LSI 的慢性非特异性下腰痛（CNLBP）患者与无临床 LSI 的 CNLBP 患者的腰椎肌肉形态。
本病例对照研究纳入了 30 例 CNLBP 患者（15 例有临床 LSI，15 例无临床 LSI）和 15 例无 LBP 的受试者。使用 L2 至 S1 腰椎水平的轴向磁共振图像来评估腰椎肌肉形态。
与对照组相比，两组 CNLBP 患者的多裂肌肌肉脂肪浸润指数显著增加，L3-L4 至 L5-S1 水平的相对多裂肌横截面积（rmCSA）显著降低（p<0.05）。与对照组相比，临床 LSI 组的竖脊肌平均 rmCSA 显著更大（SMD=0.853，95%CI=0.105 至-1.6，P=0.044），与无临床 LSI 的 CNLBP 组相比也更大（SMD=0.894，95%CI=-1.645 至-0.144，P=0.030）。
在有或无临床 LSI 的 CNLBP 患者中，多裂肌出现萎缩性变化。然而，只有在临床 LSI 组中观察到 L4-L5 腰椎水平竖脊肌的增生性变化。腰大肌没有表现出明显的萎缩或增生性变化。
