Substantial Asymmetry in Paraspinal Muscle Cross-Sectional Area in Healthy Adults Questions Its Value as a Marker of Low Back Pain and Pathology
Substantial Asymmetry in Paraspinal Muscle Cross-Sectional Area in Healthy Adults Questions Its Value as a Marker of Low Back Pain and Pathology
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DOI：
10.1097/brs.0b013e318204b05a
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发表时间：
2011-12-01
期刊：
影响因子：
3
通讯作者：
Battie, Michele C.
中科院分区：
文献类型：
--
作者：
Niemelaeinen, Riikka;Briand, Marie-Michele;Battie, Michele C.
研究设计。棘旁肌不对称的横断面研究。以无腰痛（LBP）的中年男性为样本，在磁共振图像上检查脊柱旁肌肉区域的水平和侧对侧差异。背景资料摘要。水平和侧面特异性多裂肌萎缩和脂肪浸润被认为是局部脊柱病理和腰痛的可能标志，但由于样本量小、样本年龄小和测量问题，先前的研究具有有限的普遍性。从600名双胞胎男性的一般人群样本中，包括那些报告在过去一年没有腰痛，以前没有脊柱骨折，并且在过去12个月内没有卧床休息至少1周的人。所有受试者均有最低三个腰椎节段的t2加权轴位图像。测量椎间盘中水平多裂肌和竖脊肌的总横截面积和无脂横截面积。区域测量的内部信度在0.90至0.98之间，侧面差异测量的内部信度在0.86至0.92之间。数据分析采用描述性统计和配对t检验。受试者包括126名男性，他们的平均多裂肌总CSA测量值在左右两侧分别在7.3至11.1厘米(2)和6.9至10.8厘米(2)之间，取决于水平。右侧竖脊肌平均面积为9.4 ~ 19.6 cm(2)，左侧竖脊肌平均面积为10.4 ~ 19.7 cm(2)。65%至68%的受试者右侧多裂肌大于左侧多裂肌，这取决于脊柱水平（P < 0.001）。最低三个腰椎节段的平均不对称性为10% ~ 13.2%，腰4 ~腰5节段最小。多裂侧对侧不对称性为0.1% ~ 44.3%。对于竖脊，左侧测量值趋于较大，在两个最低水平上达到统计学意义（P < 0.0001）。竖棘平均侧对侧不对称从8.2%增加到18.8%，相邻水平间差异有统计学意义（P < 0.01）。两组肌肉的肌内脂肪含量均显著增加。棘旁肌不对称大于10%常见于无腰痛史的男性。这提示在使用水平和侧面特异性棘旁肌不对称来鉴别腰痛和脊柱病理时要谨慎。
Study Design. A cross-sectional population-based study of paraspinal muscle asymmetry.Objective. To examine level-and side-to-side differences in paraspinal muscle areas on magnetic resonance images in a population-based sample of middle aged men without low back pain (LBP).Summary of Background Data. Level-and side-specific multifidus muscle atrophy and fat infiltration have been suggested as possible markers for localized spinal pathology and LBP, but prior studies have limited generalizability due to small sample sizes, young age of samples and measurement issues.Methods. From a general population sample of 600 twin men, those reporting no LBP during the prior year, no previous spinal fractures, and no bed rest for at least 1 week in the last 12 months were included in the study. All subjects had T2-weighted axial images available for the three lowest lumbar levels. Both total and fat-free cross-sectional areas (CSAs) of the multifidus and erector spinae muscles at the mid-disc level were measured. Intrarater reliability ranged between 0.90 and 0.98 for area measurements and 0.86 and 0.92 for measurements of side-to-side differences. Data were analyzed using descriptive statistics and paired t tests.Results. Subjects consisted of 126 men whose mean multifidus total CSA measurements varied between 7.3 and 11.1 cm(2) and between 6.9 and 10.8 cm(2) for right and left sides, respectively, depending on the level. The corresponding mean areas for erector spinae were 9.4 to 19.6 cm(2) for right side and 10.4 to 19.7 cm(2) for left side. The multifidus was larger on the right side than on the left side in 65% to 68% of subjects, depending on spinal level (P < 0.001). The mean asymmetry at the three lowest lumbar levels was 10% to 13.2% and was smallest at L4-L5. Multifidus side-to-side asymmetry ranged from 0.1% to 44.3%. For erector spinae, the left-side measurements tended to be larger, reaching statistical significance (P < 0.0001) for the two lowest levels. The mean side-to-side asymmetry increased caudally for erector spinae, from 8.2% to 18.8% and was significantly different between adjacent levels (P < 0.01). The amount of intramuscular fat significantly increased caudally for both muscles.Conclusion. Paraspinal muscle asymmetry greater than 10% was commonly found in men without a history of LBP. This suggests caution in using level-and side-specific paraspinal muscle asymmetry to identify subjects with LBP and spinal pathology.