Comparison of lumbar muscle morphology in patients with chronic nonspecific low back pain with and without clinical lumbar segmental instability.

OBJECTIVES: Evaluation of spinal muscle morphology may be critical because of its impact on segmental stability and control of the lumbar spine in the subset of patients with clinical lumbar segmental instability (LSI). The purpose of this study was to compare lumbar muscle morphology in CNLBP patients with clinical LSI, CNLBP patients without clinical LSI. METHODS: This case-control study included 30 patients with CNLBP (15 with clinical LSI and 15 without clinical LSI) and 15 subjects without LBP. Axial magnetic resonance images from the L2 to S1 lumbar levels were used to evaluate the morphology of the lumbar muscles. RESULTS: A significant increase in the muscle-to-fat infiltration index and a significant decrease in the relative muscle cross-sectional area (rmCSA) of the multifidus muscle at the L3-L4 to L5-S1 levels were observed in both CNLBP groups compared to the control group (p<0.05). The mean erector spinae mean rmCSA was significantly greater in the clinical LSI group compared to the control group (SMD = 0.853, 95% CI = 0.105 to -1.6, P = 0.044) and also compared to the CNLBP without clinical LSI (SMD = 0.894, 95% CI = -1.645 to -0.144, P = 0.030) at the L4-L5 level. CONCLUSIONS: The atrophic changes of the multifidus muscle, in CNLBP patients with or without clinical LSI was observed. However, hypertrophic changes of the erector spinae muscle at the L4-L5 lumbar level were observed only in the clinical LSI group. Psaos major did not show significant atrophic or hypertrophic changes.

Diaphragmatic Activation Correlated with Lumbar Multifidus Muscles and Thoracolumbar Fascia by B-Mode and M-Mode Ultrasonography in Subjects with and without Non-Specific Low Back Pain: A Pilot Study.

Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects.

Inter-Examiner Disagreement for Assessing Cervical Multifidus Ultrasound Metrics Is Associated with Body Composition Features.

Ultrasound imaging (US) is a biosensing technique that is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics, such as muscle morphology and quality. Since all biosensors need to be tested in order to demonstrate their reliability, accuracy, sensitivity, and specificity, identifying factors that affect their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are associated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the L5 level were acquired and analyzed in 47 healthy volunteers by two examiners (one experienced and one novice). The cross-sectional area, muscle perimeter, and mean echo intensity were calculated bilaterally. A correlation analysis and a multivariate linear regression model were used for assessing the inter-examiner differences with respect to body composition metrics. The results demonstrated good-to-excellent reliability estimates for the cross-sectional area, muscle perimeter, aspect ratio, roundness, circularity, and mean brightness metrics (all ICC > 0.85). However, solidity showed unacceptable reliability (ICC < 0.7). Age, height, total lean mass, trunk lean mass, and water volume were associated with inter-examiner disagreement on mean echo intensity. Cross-sectional area, perimeter, and roundness measurement errors were associated with lean mass and water volume.

The association between paraspinal muscle parameters and vertebral pedicle microstructure in patients undergoing lumbar fusion surgery.

PURPOSE: Lumbar fusion surgery has become a standard procedure in spine surgery and commonly includes the posterior placement of pedicle screws. Bone quality is a crucial factor that affects pedicle screw purchase. However, the relationship between paraspinal muscles and the bone quality of the pedicle is unknown. The aim of the study was to determine the relationship between paraspinal muscles and the ex vivo bony microstructure of the lumbar pedicle. METHODS: Prospectively, collected data of patients undergoing posterior lumbar fusion for degenerative spinal conditions was analyzed. Pre-operative lumbar magnetic resonance imaging (MRI) scans were evaluated for a quantitative assessment of the cross-sectional area (CSA), functional cross-sectional area (fCSA), and the proportion of intramuscular fat (FI) for the psoas muscle and the posterior paraspinal muscles (PPM) at L4. Intra-operative bone biopsies of the lumbar pedicle were obtained and analyzed with microcomputed tomography (µCT) scans. The following cortical (Cort) and trabecular (Trab) bone parameters were assessed: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), connectivity density (CD), bone-specific surface (BS/BV), apparent density (AD), and tissue mineral density (TMD). RESULTS: A total of 26 patients with a mean age of 59.1 years and a mean BMI of 29.8 kg/m2 were analyzed. fCSAPPM showed significant positive correlations with BV/TVTrab (ρ = 0.610; p < 0.001), CDTrab (ρ = 0.679; p < 0.001), Tb.NTrab (ρ = 0.522; p = 0.006), Tb.ThTrab (ρ = 0.415; p = 0.035), and ADTrab (ρ = 0.514; p = 0.007). Cortical bone parameters also demonstrated a significant positive correlation with fCSAPPM (BV/TVCort: ρ = 0.584; p = 0.002; ADCort: ρ = 0.519; p = 0.007). FIPsoas was negatively correlated with TMDCort (ρ = - 0.622; p < 0.001). CONCLUSION: This study highlights the close interactions between the bone microstructure of the lumbar pedicle and the paraspinal muscle morphology. These findings give us further insights into the interaction between the lumbar pedicle microstructure and paraspinal muscles.

Convolutional neural networks for the automatic segmentation of lumbar paraspinal muscles in people with low back pain.

The size, shape, and composition of paraspinal muscles have been widely reported in disorders of the cervical and lumbar spine. Measures of size, shape, and composition have required time-consuming and rater-dependent manual segmentation techniques. Convolutional neural networks (CNNs) provide alternate timesaving, state-of-the-art performance measures, which could realise clinical translation. Here we trained a CNN for the automatic segmentation of lumbar paraspinal muscles and determined the impact of CNN architecture and training choices on segmentation performance. T2-weighted MRI axial images from 76 participants (46 female; age (SD): 45.6 (12.8) years) with low back pain were used to train CNN models to segment the multifidus, erector spinae, and psoas major muscles (left and right segmented separately). Using cross-validation, we compared 2D and 3D CNNs with and without data augmentation. Segmentation accuracy was compared between the models using the Sørensen-Dice index as the primary outcome measure. The effect of increasing network depth on segmentation accuracy was also investigated. Each model showed high segmentation accuracy (Sørensen-Dice index ≥ 0.885) and excellent reliability (ICC2,1 ≥ 0.941). Overall, across all muscles, 2D models performed better than 3D models (p = 0.012), and training without data augmentation outperformed training with data augmentation (p < 0.001). The 2D model trained without data augmentation demonstrated the highest average segmentation accuracy. Increasing network depth did not improve accuracy (p = 0.771). All trained CNN models demonstrated high accuracy and excellent reliability for segmenting lumbar paraspinal muscles. CNNs can be used to efficiently and accurately extract measures of paraspinal muscle health from MRI.

Inter-rater and inter-session reliability of lumbar paraspinal muscle composition in a mobile MRI device.

OBJECTIVE: To assess the reliability of measurements of paraspinal muscle transverse relaxation times (T2 times) between two observers and within one observer on different time points. METHODS: 14 participants (9f/5m, 33 ± 5 years, 176 ± 10 cm, 73 ± 12 kg) underwent 2 consecutive MRI scans (M1,M2) on the same day, followed by 1 MRI scan 13-14 days later (M3) in a mobile 1.5 Tesla MRI. T2 times were calculated in T2 weighted turbo spin-echo-sequences at the spinal level of the third lumbar vertebrae (11 slices, 2 mm slice thickness, 1 mm interslice gap, echo times: 20, 40, 60, 80, 100 ms) for M. erector spinae (ES) and M. multifidius (MF). The following reliability parameter were calculated for the agreement of T2 times between two different investigators (OBS1 & OBS2) on the same MRI (inter-rater reliability, IR) and by one investigator between different MRI of the same participant (intersession variability, IS): Test-Retest Variability (TRV, Differences/Mean*100); Coefficient of Variation (CV, Standard deviation/Mean*100); Bland-Altman Analysis (systematic bias = Mean of the Differences; Upper/Lower Limits of Agreement = Bias+/-1.96*SD); Intraclass Correlation Coefficient 3.1 (ICC) with absolute agreement, as well as its 95% confidence interval. RESULTS: Mean TRV for IR was 2.6% for ES and 4.2% for MF. Mean TRV for IS was 3.5% (ES) and 5.1% (MF). Mean CV for IR was 1.9 (ES) and 3.0 (MF). Mean CV for IS was 2.5% (ES) and 3.6% (MF). A systematic bias of 1.3 ms (ES) and 2.1 ms (MF) were detected for IR and a systematic bias of 0.4 ms (ES) and 0.07 ms (MF) for IS. ICC for IR was 0.94 (ES) and 0.87 (MF). ICC for IS was 0.88 (ES) and 0.82 (MF). CONCLUSION: Reliable assessment of paraspinal muscle T2 time justifies its use for scientific purposes. The applied technique could be recommended to use for future studies that aim to assess changes of T2 times, e.g. after an intense bout of eccentric exercises.

Larger muscle fibers and fiber bundles manifest smaller elastic modulus in paraspinal muscles of rats and humans.

The passive elastic modulus of muscle fiber appears to be size-dependent. The objectives of this study were to determine whether this size effect was evident in the mechanical testing of muscle fiber bundles and to examine whether the muscle fiber bundle cross-section is circular. Muscle fibers and fiber bundles were extracted from lumbar spine multifidus and longissimus of three cohorts: group one (G1) and two (G2) included 13 (330 ± 14 g) and 6 (452 ± 28 g) rats, while Group 3 (G3) comprised 9 degenerative spine patients. A minimum of six muscle fibers and six muscle fiber bundles from each muscle underwent cumulative stretches, each of 10% strain followed by 4 minutes relaxation. For all specimens, top and side diameters were measured. Elastic modulus was calculated as tangent at 30% strain from the stress-strain curve. Linear correlations between the sample cross sectional area (CSA) and elastic moduli in each group were performed. The correlations showed that increasing specimen CSA resulted in lower elastic modulus for both rats and humans, muscle fibers and fiber bundles. The median ratio of major to minor axis exceeded 1.0 for all groups, ranging between 1.15-1.29 for fibers and 1.27-1.44 for bundles. The lower elastic moduli with increasing size can be explained by relatively less collagenous extracellular matrix in the large fiber bundles. Future studies of passive property measurement should aim for consistent bundle sizes and measuring diameters of two orthogonal axes of the muscle specimens.

Muscle fiber morphometry and physicochemical characteristics of the Longissimus thoracis muscle of hair male lambs fed zilpaterol hydrochloride and implanted with steroids.

Muscle fiber morphometry and physicochemical characteristics were evaluated in LT muscles obtained from entire male lambs treated with zilpaterol hydrochloride (ZH, 0 and 0.15 mg/kg body weight) and/or steroidal implant (SI, with and without trenbolone acetate/estradiol). ZH and SI acted synergistically to increase LT area, type-IIb fiber cross-sectional area and soluble collagen content, likewise to decrease metmyoglobin concentration and insoluble collagen content. Ash content and ultimate pH showed a decrease due to an antagonistic effect between ZH and SI. Content of total collagen, protein, fat, moisture, oxidized lipids and water-holding capacity were unaffected by ZH and SI. Supplemental ZH, but not SI, decreased all color parameters and tended to increase shear force. Overall, the SI implantation of male lambs followed by a ZH supplementation promoted greater LT hypertrophy, without affecting protein and fat content, and physicochemical characteristics in their meat.

Combined, Rib-Sparing, Bilateral Approach to the Ventral Mid and Low Thoracic Spine: Study on Comparative Anatomy and Surgical Feasibility.

BACKGROUND: Pathologies of the ventral thoracic spine represent a challenge, igniting arguments about which should be the ideal surgical approach to access this area. Anterior transthoracic thoracotomy and a number of posterolateral routes have been developed. Among the latter, costotransversectomy has demonstrated to provide good ventral exposure with a lower, but not negligible, morbidity. The optimal approach should be the one minimizing surgical morbidity on both neural and extraneural structures while optimizing exposure. METHODS: The authors described the combined, rib-sparing, bilateral approach (CRBA) to the ventral mid/low-thoracic spine. The technique combines a transfacet pedicle partially sparing approach on one side and a transpedicular with transverse process resection on the contralateral one. A laboratory investigation was conducted. The technique was applied in a surgical setting, and a case was reported. RESULTS: CRBA is rib-sparing, completely extracavitary, and does not require pleural exposure and paraspinal muscle splitting, thus minimizing potential morbidity. The combination of 2 corridors ensures the greatest exposure compared with standard posterolateral approaches. The only blind corner is limited to a small area just in front of the dural sac. A bimanual approach optimizes control during surgical manipulation, even if the area of maneuverability and cross-section areas of surgical corridors are slightly limited compared to traditional costotransversectomy due to the minimally invasive nature of the procedure. CONCLUSIONS: CRBA represents a safe and effective option to access the ventral mid/low thoracic spine. It provides great exposure and bimanual manipulation of the surgical target, minimizes potential morbidity, and avoids entrance into the thoracic cavity and paraspinal muscle splitting.

Seasonal Changes in Lumbar Multifidus Muscle in University Rugby Players.

PURPOSE: Although smaller lumbar multifidus muscle (LMM) was reported to be a strong predictor of lower limb injury (LLI) in Australian Football League players, LMM morphology has not been investigated in rugby athletes. This study examined seasonal changes in LMM in rugby players and whether LMM characteristics were associated with low back pain (LBP) and LLI. METHODS: Ultrasound examinations of the LMM were acquired in 21 university-level rugby players (12 women, 9 men) at preseason and end-season. LMM cross-sectional area (CSA), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing were obtained bilaterally at the L5-S1 level. The percent change in LMM thickness during contraction was calculated as follows: [(thicknesscontracted - thicknessrest)/thicknessrest × 100]. Self-reported questionnaires were used to acquire data on LBP and LLI. RESULTS: There was no significant difference in LMM characteristics between preseason and end-season measurements (P > 0.05). Preseason LMM CSA, side-to-side CSA asymmetry, and thickness at rest or during contraction were not associated with LBP or LLI. However, a lower percent thickness change in the standing position was significantly associated with having LBP during the preseason (P = 0.01) and playing season (P = 0.001), as well as LLI during the preseason (P = 0.03). CONCLUSIONS: This study provides preliminary evidence that LMM contractile ability and behavior during functional movement, such as standing, may have important implications for the susceptibility to injury among rugby athletes.

Genetic parameters associated with meat quality of Nellore cattle at different anatomical points of longissimus: Brazilian standards.

The present study estimated genetic parameters and evaluated the genetic and phenotypic correlations between meat quality characteristics of Nellore cattle evaluated at different anatomical points of the longissimus. Data from 1329 Nellore young bulls were used to evaluate, in the 5th and 12th ribs, marbling score (MAR), shear force (SF), cooking weight losses (CWL) and intramuscular fat (IMF). In addition, the subcutaneous fat thickness was measured at the 12th rib (SFT12) and between the last lumbar and the first sacral vertebrae (SFTLR), in the separation of loin and round. Results yielded moderate heritability coefficients for evaluated characteristics, except CWL. High genetic correlations (0.61) were found between measurements of SFT12 and SFTLR. MAR, IMF and SF were evaluated at the 5th and 12th rib. Meat quality and subcutaneous fat thickness measured at different anatomical points of the longissimus are genetically correlated and can be used in genetic selection programs to improve meat quality characteristics in Nellore cattle.

Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature.

OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.

Clinical utility of measuring the size of the lumbar multifidus and quadratus lumborum muscles in the Australian football league setting: A prospective cohort study.

OBJECTIVES: Test the odds of factors previously associated with lower limb injury (decreased size of the multifidus (MF) and increased size of the quadratus lumborum (QL) muscle) in an independent sample of Australian Rules Football (ARF) players. DESIGN: Prospective cohort study. SETTING: Professional ARF. PARTICIPANTS: Forty-three male ARF players. MAIN OUTCOME MEASURES: Cross-sectional areas (CSAs) of MF and QL muscles measured from pre-season ultrasound images. Playing season injuries were recorded by club personnel. A multivariable logistic regression model was used to evaluate the usefulness of MF and QL muscle size for predicting playing season lower limb injuries. RESULTS: Fifteen players (35%) sustained a playing season lower limb injury. The multivariable model indicated that the odds of sustaining a lower limb injury during the season was 2.38 (95% CI: 1.18, 5.00; P = 0.017) times less likely for a one cm2 increase from the mean value in MF muscle CSA at the L5 vertebral level after adjusting for CSA of the QL, age and BMI. The main effect and interaction models positively predicted 75% of players that sustained a lower limb injury during the season (sensitivity 80%, specificity 85%). CONCLUSION: Future studies could examine the efficacy, feasibility and adherence of 'at risk' players to a pre-season training program aimed at increasing MF muscle size and monitor playing season injuries.

Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study.

BACKGROUND: Although there is mounting evidence on sex-linked differences in paraspinal muscle function, it is unknown whether sex-based variations in mechanical and contractile characteristics of the lumbar erector spinae (LES) can be monitored noninvasively in healthy participants at rest using tensiomyography (TMG). HYPOTHESIS: Sex-specific effects in muscle displacement (Dm) and velocity of muscle deformation (Vd) will be observed via TMG assessed in the LES. STUDY DESIGN: Observational study. LEVEL OF EVIDENCE: Level 3. METHODS: LES response was measured in a relaxed state in 40 healthy adults (20 females). Possible differences between the conditions were investigated using mixed-model analyses of variance. Two-stage hierarchical linear regression analyses were performed to predict the outcome of TMG Dm and Vd based on participant sex. RESULTS: There were significant main effects of sex with large effect sizes for both TMG parameters, resulting from lower mean values in women compared with men (Dm, P < 0.01; Vd, P < 0.01). In contrast, neither the main effect of side (left vs right LES) nor the interaction between the side and sex reached significance (all P > 0.3). Introducing the sex variable in stage 2 of the regression analyses significantly improved the prediction of the TMG parameters (all ∆R2 ≥ 0.18; all P < 0.01; all f2 ≥ 0.29). CONCLUSION: Sex-based differences in muscle stiffness and contractile characteristics could be observed by TMG on LES muscles in healthy individuals at rest. The data suggest that these disparities are not exclusively attributable to anthropometric measures but may be linked to intrinsic sex-based differences in skeletal muscle characteristics. CLINICAL RELEVANCE: We recommend implementing TMG in a clinical setting using the obtained results as a basis to factor for the patient's biological sex when assessing effects of therapeutic/exercise regimens aiming at the optimization of myofascial tissue regeneration and performance.

Does Plantar Pressure Distribution Influence the Lumbar Multifidus Muscle Thickness in Asymptomatic Individuals? A Preliminary Study.

BACKGROUND: Atrophy can occur in the lumbar multifidus (LM) muscle quickly as a result of various musculoskeletal problems. Knowing factors influencing muscle thickness of the LM will provide important clues about lumbopelvic stability. OBJECTIVES: Although there are several studies in the literature investigating the adverse effects of foot-ankle postural disorders on the lumbopelvic region, to our knowledge there has been no investigation of plantar pressure distribution (PPD) as a factor influencing muscle thickness of the LM. The aim of this study was to determine whether PPD could affect LM muscle thickness. METHODS: This observational study consisted of 25 asymptomatic individuals. Ultrasonographic imaging was used to determine the thickness of the LM. All participants were subjected to PPD analysis using the Digital Biometry Scanning System and Milletrix software in 9 different plantar pressure zones. The Pearson product-moment correlation coefficients were used to examine the correlations between the LM muscle thickness and other variables. Stepwise multiple linear regression analysis was used to determine the variables with the greatest influence on LM muscle thickness. RESULTS: Peak pressures of medial and lateral zones of the heel were the significant and independent factors influencing static LM thickness, with 39.5% of the variance; moreover, the peak pressures of heel medial and fourth metatarsal bone were the significant and independent factors influencing dynamic LM thickness, with 38.7% of the variance. CONCLUSIONS: Plantar pressure distribution could be an important factor influencing LM thickness, although further research is required. Examining foot-ankle biomechanics may provide information about the stability of the LM.

Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI.

PURPOSE: To understand fat distribution patterns and ectopic fat deposition in healthy adults and to provide normative data, encompassing the borders of physiological regional muscle composition. For this purpose chemical shift encoding-based water-fat Magnetic Resonance Imaging (MRI) was used for proton density fat fraction (PDFF) calculations. MATERIAL AND METHODS: 91 volunteers were enrolled (male: n = 28, age = 36.6 ± 11.4 years; female: n = 63, age = 38.5 ± 15.1 years). PDFF values combined for the multifidus, semispinalis and spinalis cervicis muscles at the level of the 3rd cervical vertebral body (C3), the 5th cervical vertebral body (C5) and the first thoracic vertebral body (Th1) were extracted. RESULTS: The paraspinal musculature at C3 (14.8 ± 10.1 % vs. 19.2 ± 11.0 %; p = 0.029) and Th1 (13.8 ± 7.0 % vs 17.7 ± 7.4 %; p = 0.011) showed significantly lower PDFF values in men compared to women. Partial correlation testing with BMI as control variable revealed highly significant correlations between the paraspinal musculature PDFF at C3 (men: r = 0.504, p = 0.007; women: r = 0.279, p = 0.028), C5 (men: r = 0.450, p = 0.019; women: r = 0.347, p = 0.006) and Th1 (men: r = 0.652, p < 0.0001; women: r = 0.443, p < 0.0001) with age in both genders. CONCLUSION: The present data suggest gender and age-specific fat deposition patterns of the cervical and the upper cervicothoracic paraspinal muscles and may provide reference values for pathology detection.

Ultrasonography of Lumbar Multifidus Muscle in University American Football Players.

PURPOSE: The primary objective of this study was to examine and compare lumbar multifidus (LM) muscle size, asymmetry, and function in university football players with and without low back pain (LBP). A secondary objective was to examine the relationship between LM characteristics and body composition in football players. METHODS: Ultrasound assessments of the LM muscle were performed in 41 university football players during the preseason. LM muscle cross-sectional area, echo intensity (e.g., indicator of fatty infiltration and connective tissue), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing positions were obtained bilaterally at the L5-S1 level. Body composition measures were acquired using dual-energy x-ray absorptiometry. A self-administered questionnaire was used to obtain LBP history data. RESULTS: The LM muscle thickness at rest in prone and in standing was significantly smaller in football players who reported the presence of LBP in the previous 3 months. The LM cross-sectional area in prone was significantly and positively correlated with weight, height, lean body mass, total fat mass, and total percent body fat. LM echo intensity was strongly correlated with total percent body fat and total fat mass and negatively correlated with the percent thickness change during contraction. CONCLUSION: The results of this study provide novel information on LM muscle morphology and activation in football players in prone and standing and suggest that players with LBP in the previous 3 months had smaller LM muscle thickness. LM morphology was strongly correlated with body composition measurements.

Morphologic Characteristics of the Deep Cervical Paraspinal Muscles in Patients with Single-Level Cervical Spondylotic Myelopathy.

OBJECTIVE: This study aimed to compare morphologic changes of deep paraspinal muscles at C4-7 in patients with C5-6 single-level cervical spondylotic myelopathy (CSM), and to evaluate the relationship between morphologic changes and the level of spinal cord compression. METHODS: The study included 15 patients with C5-6 single-level CSM and 15 age- and sex-matched healthy subjects. Cross-sectional area (CSA) and functional CSA of the bilateral longus capitis (LCap), longus colli (LC), multifidus (MF), semispinalis cervicis (SSC), semispinalis capitis, splenius capitis, and splenius cervicis were measured on preoperative magnetic resonance images at C4-7, and calculated as ratios with respect to the corresponding vertebral body CSA. RESULTS: The mean maximum spinal cord compression was 22.30% in the CSM group. At the cranial level (C4-5), the CSM group had more fat infiltration in the MF and SSC (P < 0.05). At the spinal cord compression segment and caudal adjacent segment (C5-6 and C6-7), the degree of fat infiltration of all paravertebral muscles was aggravated, accompanied by atrophy of LCap, LC, and MF (P < 0.05). Compared between different levels, fat infiltration in the MF at C5-6 was greater than adjacent levels. CONCLUSIONS: In patients with C5-6 single-level CSM, fat infiltration and atrophy of deep paraspinal muscles, especially the Lcap, LC, and MF, mainly occurred in the level of spinal cord compression and caudal adjacent level. In the cranial adjacent segment, the degree of MF and SSC fat infiltration in patients with CSM was also aggravated. This may suggest that multiple mechanisms are involved in paraspinal muscles degeneration in CSM.

The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis.

BACKGROUND: The relationship between spinal alignment and skeletal muscle mass (SMM) has attracted attention in recent years. Sagittal alignment is known to deteriorate with age, but it is not known whether this is related to paraspinal muscles. Therefore, the purpose of this study is to elucidate the role of the multifidus (MF) and psoas major (PS) muscles in maintaining global spinal alignment in patients with lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (DS), and to analyze whether each muscles' cross-sectional area (CSA) correlates with whole-body SMM using bioimpedance analysis (BIA). METHODS: We retrospectively evaluated 140 patients who were hospitalized for surgery to treat LSS and/or DS. Spinal alignment, CSA of spinal muscles, and body composition parameters were measured from full-length standing whole-spine radiography, MRI, and BIA before surgery. The following standard measurements were obtained from radiographs: sagittal balance (C7-SVA), cervical lordosis (CL; C2-C7), lumbar lordosis (LL; L1-S1), thoracic kyphosis (TK; T5-T12), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). RESULTS: The average PS CSA (AveCSA) was highest at L4-L5, whereas MF AveCSA was highest at L5-S1. Paraspinal muscle CSAs were greater in males than in females. There was no statistically significant difference between the left and right CSA for either MF or PS. Correlation coefficient showed strong correlations between the PS AveCSA (L4-L5) and whole body SMM (r = 0.739). Correlation coefficient analysis also showed weak correlation between SMM and PT (r = - 0.184). Furthermore, PS AveCSA (L4-L5) correlated with the PT (r = - 0.183) and age (r = - 0.156), while PT correlated with the whole body SMM (r = - 0.184) but not with age. CONCLUSIONS: Whole body SMM showed correlation with PS AvCSA (L4-L5) and with PT among the spinal parameters, which was the same result in MF AvCSA (L4-L5). These findings suggest that the posterior inclination of the pelvis may be correlated with paraspinal muscle area rather than age.

Psoas and Paraspinous Muscle Measurements on Computed Tomography Predict Mortality in European Americans with Type 2 Diabetes Mellitus.

BACKGROUND: Appendicular skeletal muscle mass index and muscle attenuation (density) are negatively associated with mortality in European-derived populations. OBJECTIVES: The present analyses assessed association between axial skeletal muscle density and muscle index with mortality in European Americans with type 2 diabetes mellitus (T2D). DESIGN: Single-center observational study. SETTING: Diabetes Heart Study. PARTICIPANTS: 839 European Americans with T2D. METHODS: Computed tomography-measured psoas and paraspinous muscle mass index (cross sectional area/height2) and radiographic density (Hounsfield Units) were assessed in all participants. A Cox proportional hazards model was computed. The fully-adjusted model included covariates age, sex, body mass index, smoking, alcohol use, diabetes duration, insulin use, hormone replacement therapy (women), prevalent cardiovascular disease (CVD), hypertension, and coronary artery calcified atherosclerotic plaque mass score. Deaths were recorded in the National Death Index data through December 31, 2015. RESULTS: Participants included 428 women and 411 men with median (25th, 75th quartile) age 62.8 (56.1, 69.1) years and diabetes duration 8.0 (5.0, 14.0) years. After 11.9 (9.4, 13.3) years of follow-up, 314 (37.4%) of participants were deceased. In the fully-adjusted model, psoas muscle density (hazard ratio [HR] 0.81, p<0.001), psoas muscle index (HR 0.82, p=0.008), and paraspinous muscle density (HR 0.85, p=0.003) were inversely associated with mortality. Paraspinous muscle index was not significantly associated with mortality (HR 0.90, p=0.08). Results did not differ significantly between men and women. CONCLUSIONS: In addition to established risk factors for mortality and CVD, higher psoas muscle index, psoas muscle density, and paraspinous muscle density were significantly associated with lower all-cause mortality in European Americans with T2D.