Pinto Sabina M, Cheung Jason P Y, Samartzis Dino, Karppinen Jaro, Zheng Yong-Ping, Pang Marco Y C, Fortin Maryse, Wong Arnold Y L
Department of Rehabilitation Sciences The Hong Kong Polytechnic University Hong Kong SAR China.
Department of Orthopaedics and Traumatology The University of Hong Kong Hong Kong SAR China.
JOR Spine. 2025 May 15;8(2):e70071. doi: 10.1002/jsp2.70071. eCollection 2025 Jun.
Although individuals with chronic low back pain (CLBP) show increased fatty infiltration in the lumbar multifidus muscle (LMM), it remains unclear whether LMM changes are related to clinical outcomes (such as pain and disability) after considering confounders (spinal phenotypes, fear-avoidance beliefs [FABs] and insomnia). This study examined: (1) differences in confounders and LMM characteristics between individuals with and without CLBP; and (2) associations between confounders, LMM parameters, and clinical outcomes in the CLBP group alone.
Participants (CLBP = 70 and asymptomatic people = 67) underwent lumbar magnetic resonance imaging. Outcome measures comprised the numeric pain rating scale, the Roland-Morris Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Insomnia Severity Index (ISI) Scale. LMM morphometry at L3-S1 (cross-sectional area, total volume, and fatty infiltration) was measured using a customized MATLAB program. Spinal phenotypes (disc degeneration, high-intensity zones, Modic changes [MCs], Schmorl's nodes, facet joint degeneration [FJD], and facet tropism [FT]) were scored. The between-group differences were analyzed using linear mixed models and chi-squared/Fisher's exact tests. Univariate and multivariate analyses evaluated associations between clinical outcomes and other outcome measures in the CLBP group.
The CLBP group demonstrated more severe disc degeneration and FJD at all levels, and greater FT at L5/S1 than asymptomatic participants ( < 0.05). The average LMM total volume at L3/4 and the percentage of fatty infiltration in LMM in the L3-S1 region were greater in the CLBP group than in asymptomatic counterparts ( < 0.05). The presence of MC at L4 and FJD at L4/5 and L4-S1 was significantly related to pain intensity in the CLBP group. Similarly, FABQ-Work and ISI scores were significantly related to pain intensity (explaining 37% of the variance in pain).
The CLBP group displays more fatty infiltration in the LMM, but their LMM morphometric parameters are unrelated to pain/disability after considering spinal phenotypes, FABs, and insomnia.
尽管慢性下腰痛（CLBP）患者的腰多裂肌（LMM）脂肪浸润增加，但在考虑混杂因素（脊柱表型、恐惧回避信念[FABs]和失眠）后，LMM的变化是否与临床结局（如疼痛和功能障碍）相关仍不清楚。本研究调查了：（1）CLBP患者与非CLBP患者在混杂因素和LMM特征方面的差异；（2）仅在CLBP组中，混杂因素、LMM参数与临床结局之间的关联。
参与者（CLBP患者70例，无症状者67例）接受腰椎磁共振成像检查。结局指标包括数字疼痛评分量表、罗兰-莫里斯功能障碍问卷、恐惧回避信念问卷（FABQ）和失眠严重程度指数（ISI）量表。使用定制的MATLAB程序测量L3-S1节段的LMM形态学指标（横截面积、总体积和脂肪浸润）。对脊柱表型（椎间盘退变、高强度区、Modic改变[MCs]、许莫氏结节、小关节退变[FJD]和小关节不对称[FT]）进行评分。采用线性混合模型和卡方检验/费舍尔精确检验分析组间差异。单因素和多因素分析评估CLBP组临床结局与其他结局指标之间的关联。
与无症状参与者相比，CLBP组在所有节段均表现出更严重的椎间盘退变和FJD，且在L5/S1节段的FT更明显（<0.05）。CLBP组L3/4节段的LMM平均总体积和L3-S1区域LMM的脂肪浸润百分比高于无症状组（<0.05）。CLBP组中L4节段的MC以及L4/5和L4-S1节段的FJD与疼痛强度显著相关。同样，FABQ-工作维度得分和ISI得分与疼痛强度显著相关（解释了疼痛变异的37%）。
CLBP组的LMM脂肪浸润更多，但在考虑脊柱表型、FABs和失眠后，其LMM形态学参数与疼痛/功能障碍无关。
