Abd-Elsayed Alaa, Kurt Erkan, Kollenburg Linda, Hasoon Jamal, Wahezi Sayed E, Storlie Nicholas R
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Pain Pract. 2025 Jun;25(5):e70044. doi: 10.1111/papr.70044.
Chronic low back pain (CLBP) is a common and harmful medical condition, and in many cases, no specific radiographic cause is identified. Many cases of CLBP are refractory to treatment and will recur after the initial episode. Dysfunction of the lumbar multifidus muscle (LMM) has been increasingly identified as a possible cause of non-specific CLBP (NSCLP).
A review was conducted on the multifidus anatomy, dysfunction, diagnosis, and treatment literature.
Multifidus dysfunction has been increasingly recognized as a potential contributor to the pathogenesis of non-specific chronic low back pain. Multifidus dysfunction is thought to arise from reflex inhibition stemming from an initial insult, which decreases spinal stability and predisposes patients to further injury. Therapeutic approaches aimed at addressing multifidus dysfunction include traditional conservative management, such as patient education, non-steroidal anti-inflammatory drugs, spinal manipulation, and physical therapy. These therapies aim mainly to achieve pain relief. Treatments that restore natural multifidus function include motor control exercises and restorative neurostimulation.
Non-specific chronic low back pain is correlated with multifidus atrophy, fatty infiltration, and abnormal lumbar multifidus muscle function. This finding highlights the need for further research and clinical trials on targeted therapeutic approaches. Existing treatments on the lumbar multifidus muscle include motor control exercises and restorative neurostimulation. Unlike many conventional treatments that primarily provide symptom relief, these therapies aim to restore natural multifidus function, offering a rehabilitative rather than purely palliative approach. Motor control exercises have been shown to improve symptoms in cases of CLBP, but there is mixed evidence of their effectiveness relative to standard physical therapy. Restorative neurostimulation is a promising intervention that has been shown to provide significant, durable improvements to disability and pain. Further research on restorative therapies should be conducted using rigorous control protocols and comparative analyses with other CLBP treatment modalities.
慢性下腰痛（CLBP）是一种常见且有害的病症，在许多情况下，未发现明确的影像学病因。许多CLBP病例治疗效果不佳，初次发作后会复发。腰椎多裂肌（LMM）功能障碍越来越被认为是非特异性CLBP（NSCLP）的一个可能病因。
对多裂肌的解剖学、功能障碍、诊断和治疗方面的文献进行了综述。
多裂肌功能障碍越来越被认为是导致非特异性慢性下腰痛发病机制的一个潜在因素。多裂肌功能障碍被认为源于最初损伤引起的反射性抑制，这会降低脊柱稳定性，使患者更容易受到进一步损伤。针对多裂肌功能障碍的治疗方法包括传统的保守治疗，如患者教育、非甾体抗炎药、脊柱推拿和物理治疗。这些治疗主要旨在缓解疼痛。恢复多裂肌自然功能的治疗方法包括运动控制训练和恢复性神经刺激。
非特异性慢性下腰痛与多裂肌萎缩、脂肪浸润及腰椎多裂肌功能异常相关。这一发现凸显了对靶向治疗方法进行进一步研究和临床试验的必要性。现有的针对腰椎多裂肌的治疗方法包括运动控制训练和恢复性神经刺激。与许多主要提供症状缓解的传统治疗不同，这些治疗旨在恢复多裂肌的自然功能，提供一种康复而非单纯姑息的方法。运动控制训练已被证明可改善CLBP患者的症状，但相对于标准物理治疗，其有效性的证据不一。恢复性神经刺激是一种有前景的干预措施，已被证明能显著、持久地改善残疾状况和疼痛。应使用严格的对照方案并与其他CLBP治疗方式进行比较分析，对恢复性治疗进行进一步研究。
