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Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis.
BMC Musculoskelet Disord. 2018 Sep 27; 19(1):351.BM

Abstract

BACKGROUND

Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology.

METHODS

Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained.

RESULTS

Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis.

CONCLUSIONS

Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies.

TRIAL REGISTRATION

PROSPERO 2015: CRD42015012985.

Authors+Show Affiliations

School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia. J.Cooley@murdoch.edu.au.School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.School of Health Professions, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, DK, Denmark.Spine Centre of Southern Denmark, Ostre Hougvej 55, 5500, Middelfart, DK, Denmark. Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230, Odense M, DK, Denmark. Department of Diagnostic Imaging, Regional Hospital Silkeborg, Falkevej 1-3, 8600, Silkeborg, DK, Denmark.Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, Fredericton, New Brunswick, E3B 5A3, Canada. School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30261870

Citation

Cooley, Jeffrey R., et al. "Relationships Between Paraspinal Muscle Morphology and Neurocompressive Conditions of the Lumbar Spine: a Systematic Review With Meta-analysis." BMC Musculoskeletal Disorders, vol. 19, no. 1, 2018, p. 351.
Cooley JR, Walker BF, M Ardakani E, et al. Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2018;19(1):351.
Cooley, J. R., Walker, B. F., M Ardakani, E., Kjaer, P., Jensen, T. S., & Hebert, J. J. (2018). Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis. BMC Musculoskeletal Disorders, 19(1), 351. https://doi.org/10.1186/s12891-018-2266-5
Cooley JR, et al. Relationships Between Paraspinal Muscle Morphology and Neurocompressive Conditions of the Lumbar Spine: a Systematic Review With Meta-analysis. BMC Musculoskelet Disord. 2018 Sep 27;19(1):351. PubMed PMID: 30261870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis. AU - Cooley,Jeffrey R, AU - Walker,Bruce F, AU - M Ardakani,Emad, AU - Kjaer,Per, AU - Jensen,Tue S, AU - Hebert,Jeffrey J, Y1 - 2018/09/27/ PY - 2018/03/21/received PY - 2018/09/18/accepted PY - 2018/9/29/entrez PY - 2018/9/29/pubmed PY - 2019/1/29/medline KW - Lumbar spine KW - canal stenosis KW - disc herniation KW - facet arthrosis KW - fat infiltration KW - paraspinal muscle KW - radiculopathy SP - 351 EP - 351 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 19 IS - 1 N2 - BACKGROUND: Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology. METHODS: Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained. RESULTS: Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis. CONCLUSIONS: Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies. TRIAL REGISTRATION: PROSPERO 2015: CRD42015012985. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/30261870/Relationships_between_paraspinal_muscle_morphology_and_neurocompressive_conditions_of_the_lumbar_spine:_a_systematic_review_with_meta_analysis_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2266-5 DB - PRIME DP - Unbound Medicine ER -