Lumbar Extensor and Flexor Muscle Structural Changes in Young Female Nurses with Chronic Bilateral Non-Specific Low Back Pain: A Case-Control Study.

ABSTRACT

BACKGROUND: Muscle structural studies on non-specific low back pain in young female nurses are rare. This study aimed to investigate the changes of lumbar extensor and flexor muscle cross-sectional area and fatty infiltration in young female nurses with chronic bilateral non-specific low back pain by lumbar spine magnetic resonance imaging to speculate on the possible pathogenesis. METHODS: The magnetic resonance imaging (MRI) data of 58 female nurses with chronic bilateral non-specific low back pain and 60 healthy female controls were analyzed retrospectively. The lumbar extensor and flexor muscle cross-sectional area/intervertebral disc cross-sectional area ratio, as well as magnetic resonance imaging signal intensity of lumbar extensor (erector spinae; multifidus) and flexor muscles (psoas muscle) were measured, calculated and compared between nurses and healthy controls by independent samples t-test. In addition, each mean MRI signal intensity of lumbar extensor or flexor muscles in nurses at different anatomical segments from lumbar vertebrae 2 (L2)-L3 to L5-sacral vertebrae 1 (S1) was also compared, and one-way Analysis of Variance (ANOVA) analyzed the mean MRI signal intensity between muscles in nurses with multiple comparisons. RESULTS: There was no significant difference in lumbar extensor and flexor muscle cross-sectional area/intervertebral disc cross-sectional area ratio between nurses with chronic bilateral non-specific low back pain and healthy controls, p > 0.01. The magnetic resonance imaging signal intensity in lumbar extensor and flexor muscle was significantly higher in nurses with chronic bilateral non-specific low back pain than in healthy controls, p < 0.01. The MRI signal intensity of lumbar extensor muscle at the lower lumbar segments was higher than at the upper ones. The magnetic resonance imaging signal intensity of the extensor muscle (erector spinae; multifidus) was significantly higher than that of the flexor muscle (psoas muscle), p < 0.01. CONCLUSIONS: This study showed that young nurses with chronic bilateral non-specific low back pain have lumbar extensor and flexor muscle fatty infiltration without muscle atrophy. We hypothesized that muscle fatty infiltration may occur prior to muscle atrophy. Therefore, the high fatty infiltration of the lumbar extensor and flexor muscle may be a cause or a result of chronic bilateral non-specific low back pain in young nurses.