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Journal ArticleDOI: 10.1080/02688697.2020.1783434

Reciprocal relationship between multifidus and psoas at L4-L5 level in women with low back pain.

04 Mar 2021-British Journal of Neurosurgery (Taylor & Francis)-Vol. 35, Iss: 2, pp 220-228
Abstract: Background Low back pain (LBP) may originate from different sources such as intervertebral disc degeneration (IVDD), end-plate and paraspinal muscle changes Our aim is to explore the relevance of

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Topics: Low back pain (58%), Intervertebral disc (54%)
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8 results found


Open access
01 Jan 2010-
Abstract: STUDY DESIGN Cross-sectional design. OBJECTIVES To investigate lumbar multifidus (LM) thickness differences, using ultrasound imaging in people during remission from recurrent low back pain (LBP) and healthy participants, during the following lower extremity movements: (1) active straight leg raise (ASLR), (2) crook-lying active leg raise (CLR), and (3) prone straight leg raise (PSLR). BACKGROUND ASLR, CLR, and PSLR are used clinically to challenge the ability of the trunk muscles to control spinal motion in people with LBP, and it is believed that decreased LM activity is related to altered spinal control in this population. However, it is unclear whether LM behavior differs between healthy individuals and people with recurrent LBP during symptom remission in such tasks. METHODS The present study used ultrasound imaging to measure LM percentage thickness change parasagitally at the L4-5 and L5-S1 levels in people with recurrent LBP during symptom remission and in healthy participants, during the ASLR, CLR, and PSLR tasks. RESULTS LM percentage thickness change was greater in the recurrent LBP group than in healthy participants during the PSLR task (P<.01) and greater in both groups during the PSLR than the ASLR and CLR tasks (P<.01). LM percentage thickness change was greatest at L4-5 in both groups (P<.01) and during all tasks (P≤.02). No difference was found in LM percentage thickness change between groups in either the ASLR (P = .70) or CLR (P = .69) task. CONCLUSIONS These data suggest that, during symptom remission, individuals with recurrent LBP, compared to healthy individuals, may have greater activity in at least some parts of the LM. Further investigation is required to determine whether the LM percentage thickness change observed in this study may be explained by differential changes in deep and/or superficial fibers of LM activity. This observation may have implications for clinical practice, but requires further investigation.

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Topics: Lumbar (56%)

48 Citations


Journal ArticleDOI: 10.1016/J.CLINEURO.2020.106120
Abstract: Objective We aimed to develop a new scoring system for spinal degeneration including Modic changes, fatty infiltration (fi) in the paraspinal muscles, and intervertebral disc degeneration (IVDD), briefly Mo-fi-disc, using current radiological classification systems. We also aimed to understand whether Mo-fi-disc could predict patients with more intense low back pain (LBP). Patients and Methods We conducted a cross-sectional analysis of a retrospective database between March 2018 and July 2020. We evaluated patients in terms of Modic changes, fatty infiltration in the paraspinal muscles, and IVDD at all lumbar levels on lumbar spine MRI. We grouped patients based on their LBP intensity. Visual analog scale (VAS) scores were used for LBP intensity. Results We evaluated 134 patients (female: 66, male: 68; mean age: 35.44 ± 6.5 years). Patients with higher VAS scores had significantly higher ‘Mo-disc’ scores and higher ‘fi’ scores compared to those with lower VAS scores (3.54 ± 2.7 vs. 2.55 ± 2.8, p = 0.0075; 6.85 ± 3.2 vs. 5.25 ± 2.9, p = 0.0092). Patients with higher VAS scores had significantly higher ‘Mo-fi-disc’ scores compared to those with lower VAS scores (10.4 ± 4.2 vs. 7.94 ± 3.8, p = 0.0003). The most significant predictor for patients with higher VAS scores was ‘Mo-fi-disc’ scoring system with an OR of 1.193 (95 % CI: 1.055–1.349, p = 0.005). Conclusion Patients with more intense LBP had higher ‘Mo-fi-disc’ scores. This scoring system suggests an easy and objective classification to evaluate the spinal degeneration.

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Topics: Modic changes (52%), Low back pain (50%), Lumbar (50%)

4 Citations


Journal ArticleDOI: 10.1080/14656566.2020.1817384
Abstract: Treating chronic low back pain (LBP) can be challenging, and the most effective pharmacological therapy is controversial. The present systematic review investigated the efficacy of various pharmaco...

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Topics: Low back pain (61%)

3 Citations


Journal ArticleDOI: 10.1097/BPB.0000000000000833
Abstract: Objectives The prevalence of low-back pain (LBP) in adolescents ranges from 7 to 72%. We aimed to define the radiologic characteristics of the lumbar spine in children and adolescents with LBP with/without leg pain. Methods Two hundred and fourteen children and adolescents, who were born between 2001 and 2009 and had lumbar spine MRI for LBP with/without leg pain, were evaluated in terms of intervertebral disc degeneration (IVDD), end-plates and paraspinal muscle changes on lumbar spine MRIs. Results Severe IVDD was detected at all lumbar levels except for L2-L3. Modic changes were present in 4.2% of the patients. Modic changes were more common in patients with severe IVDD than in those with mild-to-moderate IVDD. Severe IVDD was significantly associated with Modic changes at the corresponding L1-L2 and L3-L4 disc levels. Girls had significantly more fatty infiltration in the paraspinal muscles when compared to boys. The risk of having severe IVDD concomitant with Modic changes was high [odds ratio (OR), 8.6]. The OR was 20.7 for predicting the presence of severe IVDD at any level if Modic changes presented particularly at the L3-L4 level. The ORs of Modic changes presented at any lumbar level at the background of fat-infiltrated multifidus at L3-L4 and L4-L5 levels were 8.3 and 9.1, respectively. Conclusions Fatty infiltration in the paraspinal muscles and IVDD were closely associated with Modic changes in children and adolescents with LBP. Lumbar IVDD in children and adolescents could be the result of a mechanical pathology.

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Topics: Modic changes (67%), Lumbar (53%), Low back pain (52%)

2 Citations


Open accessJournal ArticleDOI: 10.2147/JPR.S306280
Wei Li1, Yinan Gong1, Jingyi Liu1, Yongming Guo1  +6 moreInstitutions (1)
Abstract: Chronic low back pain (CLBP), lasting >3 months, is the end result of multiple pathogenic factors. Unfortunately, little is known about CLBP pathogenesis, which limits its advancements in clinical therapy and disease management. This paper summarizes the known pathological axes of CLBP, involving both peripheral and central systems. In particular, this paper details injurious nerve stimulation, inflammation-induced peripheral pathway, and central sensitization. Lumbar components, such as intervertebral disc (IVD), facet joints, muscles, fascia, ligaments, and joint capsules, contain pain receptors called nociceptors. Degeneration of the aforementioned lumbar components activates inflammatory pathways, which can directly damage nerves, lower nociceptor threshold to fire action potentials (AP), and cause pain. Additionally, damaged lumbar IVDs and endplates can also lead to the pathologic invasion of nerve growth and innervation, followed by the compression of herniated IVDs on nerve roots, thereby causing traumatic neuropathic pain. The central mechanism of CLBP involves alteration of the sensory processing of the brain and malfunction of the descending pain modulatory system, which facilitates pain amplification in the center nervous system (CNS). Lastly, abnormalities in the brain biochemical metabolism, activation of glial cells, and subsequent inflammation also play important roles in CLBP development. Taken together, inflammation plays an important role in both peripheral and central sensitization of CLBP. Due to the heterogeneity of CLBP, its pathological mechanism remains complex and difficult to understand. Therefore, it is a worthy field for future research into the subcomponents of CLBP pathogenesis, in order to distinguish the specific form of the disease, identify its origins, and develop corresponding highly effective comprehensive therapy against CLBP.

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Topics: Neuropathic pain (50%)

2 Citations


References
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57 results found


Journal ArticleDOI: 10.1097/00007632-200109010-00011
01 Sep 2001-Spine
Abstract: Study design A reliability study was conducted Objectives To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system Summary of background data A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations The reliability of the assessment has a crucial influence on the validity of the data Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse Methods A grading system for lumbar disc degeneration was developed on the basis of the literature An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years) All scans were analyzed independently by three observers Intra- and interobserver reliabilities were assessed by calculating kappa statistics Results There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 084-090) and interobserver (kappa range, 069-081) Complete agreement was obtained, on the average, in 838% of all the discs A difference of one grade occurred in 159% and a difference of two or more grades in 13% of all the cases Conclusion Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation

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2,506 Citations


Journal ArticleDOI: 10.1097/00003086-199407000-00014
Abstract: A preoperative computed tomography (CT) scan grading muscular fatty degeneration in five stages was done in 63 patients scheduled for repair of a torn rotator cuff. The results were compared with postoperative evaluation done after a mean of 17.7 months in 57 patients. Postoperative arthrographies were also performed in 56 patients. Preoperative CT scans demonstrated that infraspinatus fatty degeneration can occur in the presence of large anterosuperior tears even when the infraspinatus tendon is not torn; it worsens with time. The subscapularis rarely degenerates, and when it does it degenerates moderately, even when its tendon is not torn. After an effective surgical repair, moderate supraspinatus degeneration regressed in six of 14 patients; that of the infraspinatus never regressed but rather, increased, in three patients. One of these deteriorations, involving both supra- and infraspinatus, could probably be attributed to a partial subscapular nerve injury. Infraspinatus degeneration was correlated with functional pre- and postoperative impairment of active external rotation. Recurrence of infraspinatus tear was never observed, but recurrence occurred in 25% of supraspinatus repairs. Infraspinatus degeneration had a highly negative influence on the outcome of supraspinatus repairs. It seems preferable to operate on wide tears before irreversible muscular damage takes place.

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Topics: Rotator cuff (66%), Supraspinatus muscle (64%), Infraspinatus muscle (63%) ... show more

2,208 Citations



Open accessJournal ArticleDOI: 10.1111/J.1365-2702.2005.01121.X
Abstract: Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.

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Topics: Verbal Rating Scale (74%), Numeric Rating Scale (68%), Rating scale (62%) ... show more

1,958 Citations


Journal ArticleDOI: 10.1148/RADIOLOGY.166.1.3336678
01 Jan 1988-Radiology
Abstract: The authors reviewed magnetic resonance (MR) images of 474 consecutive patients referred for lumbar spine MR imaging. Type 1 changes (decreased signal intensity on T1-weighted spin-echo images and increased signal intensity on T2-weighted images) were identified in 20 patients (4%) and type 2 (increased signal intensity on T1-weighted images and isointense or slightly increased signal intensity on T2-weighted images) in 77 patients (16%). In all cases there was evidence of associated degenerative disk disease at the level of involvement. Histopathologic sections in three cases of type 1 change demonstrated disruption and fissuring of the end plates and vascularized fibrous tissue, while in three cases of type 2 change they demonstrated yellow marrow replacement. In addition, 16 patients with end-plate changes documented with MR were studied longitudinally. Type 1 changes in five of six patients converted to a type 2 pattern in 14 months to 3 years. Type 2 changes in ten patients remained stable over a 2-3...

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1,436 Citations