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Structural changes of lumbar muscles in non-specific low back pain

Dorien Goubert UGent, Jessica Van Oosterwijck UGent, Mira Meeus UGent and Lieven Danneels UGent (2016) PAIN PHYSICIAN. 19(7). p.E985-E999
abstract
Background: Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized by a decrease in cross-sectional area and an increase in fat infiltration in the lumbar paraspinal muscles. In addition microscopic changes, such as changes in fiber distribution, might occur. Inconsistencies in results from different studies make it difficult to draw firm conclusions on which structural changes are present in the different types of non-specific LBP. Insights regarding structural muscle alterations in LBP are, however, important for prevention and treatment of non-specific LBP. Objective: The goal of this article is to review which macro- and/or microscopic structural alterations of the lumbar muscles occur in case of non-specific chronic low back pain (CLBP), recurrent low back pain (RLBP), and acute low back pain (ALBP). Study Design: Systematic review. Setting: All selected studies were case-control studies. Methods: A systematic literature search was conducted in the databases PubMed and Web of Science. Only full texts of original studies regarding structural alterations (atrophy, fat infiltration, and fiber type distribution) in lumbar muscles of patients with non-specific LBP compared to healthy controls were included. All included articles were scored on methodological quality. Results: Fifteen studies were found eligible after screening title, abstract, and full text for inclusion and exclusion criteria. In CLBP, moderate evidence of atrophy was found in the multifidus; whereas, results in the paraspinal and the erector spinae muscle remain inconclusive. Also moderate evidence occurred in RLBP and ALBP, where no atrophy was shown in any lumbar muscle. Conflicting results were seen in undefined LBP groups. Results concerning fat infiltration were inconsistent in CLBP. On the other hand, there is moderate evidence in RLBP that fat infiltration does not occur, although a larger muscle fat index was found in the erector spinae, multifidus, and paraspinal muscles, reflecting an increased relative amount of intramuscular lipids in RLBP. However, no studies were found investigating fat infiltration in ALBP. Restricted evidence indicates no abnormalities in fiber type in the paraspinal muscles in CLBP. No studies have examined fiber type in ALBP and RLBP. Limitations: Lack of clarity concerning patient definitions, exact LBP symptoms, and applied methods. Conclusions: The results indicate atrophy in CLBP in the multifidus and paraspinal muscles but not in the erector spinae. No atrophy was shown in RLBP and ALBP. Fat infiltration did not occur in RLBP, but results in CLBP were inconsistent. No abnormalities in fiber type in the paraspinal muscles were found in CLBP.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
Low back pain, non-specific, chronic, recurrent, acute, muscle structure, fat infiltration, cross-sectional area, fiber type, review, CROSS-SECTIONAL AREA, HEALTHY CONTROL SUBJECTS, MULTIFIDUS MUSCLE, PARASPINAL MUSCLES, TRUNK MUSCLES, ASYMPTOMATIC VOLUNTEERS, DIFFERENT POSTURES, FAT INFILTRATION, SIZE, MEN
journal title
PAIN PHYSICIAN
Pain Physician
volume
19
issue
7
pages
E985 - E999
Web of Science type
Review
Web of Science id
000390121800004
JCR category
ANESTHESIOLOGY
JCR impact factor
2.84 (2016)
JCR rank
11/31 (2016)
JCR quartile
2 (2016)
ISSN
1533-3159
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
8516069
handle
http://hdl.handle.net/1854/LU-8516069
date created
2017-03-28 19:37:26
date last changed
2017-04-06 10:10:00
@article{8516069,
  abstract     = {Background: Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized by a decrease in cross-sectional area and an increase in fat infiltration in the lumbar paraspinal muscles. In addition microscopic changes, such as changes in fiber distribution, might occur. Inconsistencies in results from different studies make it difficult to draw firm conclusions on which structural changes are present in the different types of non-specific LBP. Insights regarding structural muscle alterations in LBP are, however, important for prevention and treatment of non-specific LBP. 
Objective: The goal of this article is to review which macro- and/or microscopic structural alterations of the lumbar muscles occur in case of non-specific chronic low back pain (CLBP), recurrent low back pain (RLBP), and acute low back pain (ALBP). 
Study Design: Systematic review. 
Setting: All selected studies were case-control studies. 
Methods: A systematic literature search was conducted in the databases PubMed and Web of Science. Only full texts of original studies regarding structural alterations (atrophy, fat infiltration, and fiber type distribution) in lumbar muscles of patients with non-specific LBP compared to healthy controls were included. All included articles were scored on methodological quality. 
Results: Fifteen studies were found eligible after screening title, abstract, and full text for inclusion and exclusion criteria. In CLBP, moderate evidence of atrophy was found in the multifidus; whereas, results in the paraspinal and the erector spinae muscle remain inconclusive. Also moderate evidence occurred in RLBP and ALBP, where no atrophy was shown in any lumbar muscle. Conflicting results were seen in undefined LBP groups. Results concerning fat infiltration were inconsistent in CLBP. On the other hand, there is moderate evidence in RLBP that fat infiltration does not occur, although a larger muscle fat index was found in the erector spinae, multifidus, and paraspinal muscles, reflecting an increased relative amount of intramuscular lipids in RLBP. However, no studies were found investigating fat infiltration in ALBP. Restricted evidence indicates no abnormalities in fiber type in the paraspinal muscles in CLBP. No studies have examined fiber type in ALBP and RLBP. 
Limitations: Lack of clarity concerning patient definitions, exact LBP symptoms, and applied methods. 
Conclusions: The results indicate atrophy in CLBP in the multifidus and paraspinal muscles but not in the erector spinae. No atrophy was shown in RLBP and ALBP. Fat infiltration did not occur in RLBP, but results in CLBP were inconsistent. No abnormalities in fiber type in the paraspinal muscles were found in CLBP.},
  author       = {Goubert, Dorien and Van Oosterwijck, Jessica and Meeus, Mira and Danneels, Lieven},
  issn         = {1533-3159},
  journal      = {PAIN PHYSICIAN},
  keyword      = {Low back pain,non-specific,chronic,recurrent,acute,muscle structure,fat infiltration,cross-sectional area,fiber type,review,CROSS-SECTIONAL AREA,HEALTHY CONTROL SUBJECTS,MULTIFIDUS MUSCLE,PARASPINAL MUSCLES,TRUNK MUSCLES,ASYMPTOMATIC VOLUNTEERS,DIFFERENT POSTURES,FAT INFILTRATION,SIZE,MEN},
  language     = {eng},
  number       = {7},
  pages        = {E985--E999},
  title        = {Structural changes of lumbar muscles in non-specific low back pain},
  volume       = {19},
  year         = {2016},
}

Chicago
Goubert, Dorien, Jessica Van Oosterwijck, Mira Meeus, and Lieven Danneels. 2016. “Structural Changes of Lumbar Muscles in Non-specific Low Back Pain.” Pain Physician 19 (7): E985–E999.
APA
Goubert, D., Van Oosterwijck, J., Meeus, M., & Danneels, L. (2016). Structural changes of lumbar muscles in non-specific low back pain. PAIN PHYSICIAN, 19(7), E985–E999.
Vancouver
1.
Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. PAIN PHYSICIAN. 2016;19(7):E985–E999.
MLA
Goubert, Dorien, Jessica Van Oosterwijck, Mira Meeus, et al. “Structural Changes of Lumbar Muscles in Non-specific Low Back Pain.” PAIN PHYSICIAN 19.7 (2016): E985–E999. Print.