Association of the Cross-Sectional Area, Muscularity, and Muscle-Fat Ratio of the Paraspinal Muscles with Chronic Low Back Pain
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Abstract
Background: It is now a well-established fact that paraspinal muscle integrity plays a critical role in low back pain. We aimed to determine the association of the cross-sectional area (CSA), muscle disc ratio (muscularity), and muscle fat ratio of the paraspinal muscles with chronic low back pain (CLBP) of varied pathologies, and the effect of aging and BMI.
Results: The CSAs of the muscles did not differ significantly between the two groups except for multifidus (p<0.05) and psoas (p<0.001) at L1-L2, and psoas (p<0.001) at L2-L3. There was significant difference in CSA of disc at L3-L4, L4-L5, L5-S1 (p<0.05), muscle fat ratio (p<0.01) and muscularity of multifidus and psoas (p<0.05) from L1 to L5 levels. There was no correlation of age and BMI with the CSA. Aging led to fatty infiltration in both the groups. The CSAs of muscles and discs were comparable (p>0.05) among subgroups except at few spinal levels. Muscularity among the subgroups varied at different levels. The muscle fat ratio were comparable (p>0.05).
Conclusion: Muscularity and composition rather than overall CSA of important spinal stabilizers are associated with CLBP. Age and BMI has no correlation to CSA of paraspinal muscles. Various disc and muscle parameters do not differ much among common lumbar pathologies.
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13. Niemelainen R, Briand MM, Battie MC. Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine (Phila Pa 1976). 2011;36(25):2152-7. doi: 10.1097/BRS.0b013e318204b05a. [PubMed: 21343855].
14. MengiardiB,SchmidMR,BoosN,PfirrmannCW,BrunnerF, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786-92. doi: 10.1148/radiol.2403050820. [PubMed: 16926328].
15. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9(4):266-72. doi: 10.1007/s005860000190. [PubMed: 11261613]. [PubMed Central: PMC3611341].
16. Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: A systematic review with a focus on blinding. Phys Ther. 2013;93(7):873-88. doi: 10.2522/ptj.20120457. [PubMed: 23504343]. [PubMed Central: PMC3704232].
17. Osirix Imaging Software [Online]. [cited 2017 Feb 10]; Available from: URL: http://www.osirix-viewer.com.
18. Bostrom AF, Hielm-Bjorkman AK, Chang YM, Weller R, Davies ES. Comparison of cross sectional area and fat infiltration of the epaxial muscles in dogs with and without spinal cord compression. Res Vet Sci. 2014;97(3):646-51. doi: 10.1016/j.rvsc.2014.09.006. [PubMed: 25294251].
19. Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976 ). 1993;18(7):830-6. doi: 10.1097/00007632- 199306000-00004. [PubMed: 8316880].
20. Ropponen A, Videman T, Battie MC. The reliability of paraspinal muscles composition measurements using routine spine MRI and their association with back function.
2. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145-9. doi: 10.1053/crad.1999.0340. [PubMed: 10657162].
3. Lee SW, Chan CK, Lam TS, Lam C, Lau NC, Lau RW, et al. Relationship between low back pain and lumbar multifidus size at different postures. Spine (Phila Pa 1976). 2006;31(19):2258-62. doi: 10.1097/01.brs.0000232807.76033.33. [PubMed: 16946664].
4. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2. doi: 10.1186/1741-7015-5-2. [PubMed: 17254322]. [PubMed Central: PMC1796893].
5. Kamaz M, Kiresi D, Oguz H, Emlik D, Levendoglu F. CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Interv Radiol. 2007;13(3):144-8. [PubMed: 17846989].
6. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008;13(1):43-9. doi: 10.1016/j.math.2006.07.017. [PubMed: 17070721].
7. Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2009;14(5):496-500. doi: 10.1016/j.math.2008.09.006. [PubMed: 19027343].
8. Singh R, Yadav SK, Sood S, Yadav RK, Rohilla R. Magnetic resonance imaging of lumbar trunk parameters in chronic low backache patients and healthy population: A comparative study. Eur Spine J. 2016;25(9):2864-72. doi: 10.1007/s00586-016-4698-7. [PubMed: 27421282].
9. Stokes MJ, Cooper RG, Morris G, Jayson MI. Selective changes in multifidus dimensions in patients with chronic low back pain. Eur Spine J. 1992;1(1):38-42. doi: 10.1007/BF00302141. [PubMed: 20054946].
10. Lee HI, Song J, Lee HS, Kang JY, Kim M, Ryu JS. Association between cross-sectional areas of lumbar muscles on magnetic resonance imaging and chronicity of low back pain. Ann Rehabil Med. 2011;35(6):852-9. doi: 10.5535/arm.2011.35.6.852. [PubMed: 22506214]. [PubMed Central: PMC3309393].
11. Hides JA, Stanton WR, McMahon S, Sims K, Richardson CA. Effect of stabilization training on multifidus muscle cross- sectional area among young elite cricketers with low back pain. J Orthop Sports Phys Ther. 2008;38(3):101-8. doi: 10.2519/jospt.2008.2658. [PubMed: 18349481].
12. Kim WH, Lee SH, Lee DY. Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc. 2011;50(3):201-4. doi: 10.3340/jkns.2011.50.3.201. [PubMed: 22102949]. [PubMed Central: PMC3218178].
13. Niemelainen R, Briand MM, Battie MC. Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine (Phila Pa 1976). 2011;36(25):2152-7. doi: 10.1097/BRS.0b013e318204b05a. [PubMed: 21343855].
14. MengiardiB,SchmidMR,BoosN,PfirrmannCW,BrunnerF, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786-92. doi: 10.1148/radiol.2403050820. [PubMed: 16926328].
15. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9(4):266-72. doi: 10.1007/s005860000190. [PubMed: 11261613]. [PubMed Central: PMC3611341].
16. Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: A systematic review with a focus on blinding. Phys Ther. 2013;93(7):873-88. doi: 10.2522/ptj.20120457. [PubMed: 23504343]. [PubMed Central: PMC3704232].
17. Osirix Imaging Software [Online]. [cited 2017 Feb 10]; Available from: URL: http://www.osirix-viewer.com.
18. Bostrom AF, Hielm-Bjorkman AK, Chang YM, Weller R, Davies ES. Comparison of cross sectional area and fat infiltration of the epaxial muscles in dogs with and without spinal cord compression. Res Vet Sci. 2014;97(3):646-51. doi: 10.1016/j.rvsc.2014.09.006. [PubMed: 25294251].
19. Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976 ). 1993;18(7):830-6. doi: 10.1097/00007632- 199306000-00004. [PubMed: 8316880].
20. Ropponen A, Videman T, Battie MC. The reliability of paraspinal muscles composition measurements using routine spine MRI and their association with back function.
| Files | ||
| Issue | Vol 11 No 1 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i1.18005 | |
| Keywords | ||
| Low back pain Paraspinal muscles Magnetic Resonance Imaging Intervertebral Disc | ||
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How to Cite
1.
Singh R, Kumar P, Wadhwani J, Kaur S, Singh H. Association of the Cross-Sectional Area, Muscularity, and Muscle-Fat Ratio of the Paraspinal Muscles with Chronic Low Back Pain. J Orthop Spine Trauma. 2025;11(1):1-10.
