Is there a relationship between lower lumbar disc herniation and multifidus muscle volume in postmenopausal women?
Keywords:Lumbar disc herniation, Multifidus muscle, Muscle degeneration, Fatty infiltration
Background/Aim: Lumbar disc herniation (LDH) is the most common cause of low back pain. It can also cause radiculopathy, sciatica, loss of sensation and motor loss due to pressure on the nerve roots. The multifidus muscle protects the lumbar axis. The aim of this study is to investigate the relationship between volumetric measurements and the degree of atrophy in the multifidus muscles with LDH in postmenopausal women. Methods: This case-control, retrospective study included 207 postmenopausal women with disc herniation on lumbar magnetic resonance imaging (MRI) and 183 reproductive period-premenopausal women with a mean age of 47.12 (10.07) years who were admittd to Adıyaman Training and Research Hospital between March 2020 and March 2021. LDH was detected at L4-L5 and L5-S1 levels on axial T2W lumbar MRI images. At these levels, the multifidus muscle volume was measured from the superior and inferior end plates of the vertebral bodies. The measurement of total volume was called multifidus total muscle volume (M-TMV), and the measurement made from the area without fat infiltration was called multifidus functional muscle volume (M-FMV). The M-TMV/FMV value was obtained to determine the degree of fat atrophy. Statistical analyses were performed, in which P<0.05 was considered statistically significant. Results: The mean age of women in postmenopausal period with L4-L5 and L5-S1 intervertebral disc degeneration was 66.27 (12.33) years (57-84 years). M-TMV and M-FMV values were significantly lower and M-TMV / FMV values were significantly higher in postmenopausal women compared to the control group (P<0.001). In ROC analysis, the sensitivity and specificity of M-TMV / FMV above a cut-off value of 1.67 in diagnosing LDH at L4-L5 in postmenopausal women were 96.1%, and 73.7%, respectively, while the sensitivity and specificity of M-TMV / FMV above a cut-off value of 1.46 in diagnosing LDH at L5-S1 were 89.3%, and 71.4% (P<0.001), respectively. Conclusions: This study reveals that in patients suffering from LDH in the postmenopausal period, atrophy of the multifidus muscle has negative effects and volumetric measurements of these muscles can be diagnostic in determining the degree of LDH. While planning LDH treatment in postmenopausal women, muscle strengthening programs planned after MRI evaluation may be beneficial for reducing symptoms.
Benzakour T, Igoumenou V, Mavrogenis AF, Benzakour A. Current concepts for lumbar disc herniation. Int Orthopaed. 2019;43(4):841–51.
Sanderson SP, Houten J, Errico T, Forshaw D, Bauman J, Cooper PR. The unique characteristics of “upper” lumbar disc herniations. Neurosurgery. 2004;55(2):385-9.
Yüce I, Kahyaoğlu O, Mertan P, Çavuşoğlu H, Aydın Y. Analysis of clinical characteristics and surgical results of upper lumbar disc herniations. Neurochirurgie. 2019;65(4):158–63.
Fortin M, Lazary A, Varga PP, McCall I, Battie MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J. 2016;25(5):1452-9.
Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine (Phila Pa 1976). 1997;22(19):2207–12.
MacDonald DA, Moseley GL, Hodges PW. The lumbar multifidus: does the evidence support clinical beliefs? Man Ther. 2006;11(4):254-63.
Ward SR, Kim CW, Eng CM, Gottschalk LJt, Tomiya A, Garfin SR, et al. Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. J Bone Joint Surg Am. 2009;91(1):176–85.
Macintosh JE, Bogduk N. The biomechanics of the lumbar multifidus. Clin Biomech (Bristol Avon). 1986;1(4):205–13.
Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2(2):142–6. Quiz 141 p following 167.
Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, Hodler J. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786–92.
Colakoglu B, Alis D. Evaluation of lumbar multifidus muscle in patients with lumbar disc herniation: are complex quantitative MRI measurements needed? J Int Med Res. 2019;47(8):3590–600.
Altinkaya N, Cekinmez M. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging. Skeletal Radiol. 2016;45(1):73–7.
Kalichman L, Carmeli E, Been E. The association between Imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int. 2017;2017:1–14.
Bailey A. Risk factors for low back pain in women: still more questions to be answered. Menopause 2009;16:3-4.
Song XX, Yu YJ, Li XF, et al. Estrogen receptor expression in lumbar intervertebral disc of the elderly: gender- and degeneration degree-related variations. Joint Bone Spine 2014;81:250-253.
Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol. 2010 Apr;194(4):1095-8. doi: 10.2214/AJR.09.2772. PMID: 20308517.
Ekin EE, Kurtul Yıldız H, Mutlu H. Age and sex-based distribution of lumbar multifidus muscle atrophy and coexistence of disc hernia: an MRI study of 2028 patients. Diagn Interv Radiol. 2016a;22(3):273-6.
Okada Y. Histochemical study on the atrophy of the quadriceps femoris muscle caused by knee joint injuries of rats. Hiroshima J Med Sci. 1989;38(1):13–21.
Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9.
Min SH, Kim MH, Seo JB, Lee JY, Lee DH. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J. 2009;3(2):89–95.
Faur C, Patrascu JM, Haragus H, Anglitoiu B. Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord. 2019;20(1):414.
Bouche KG, Vanovermeire O, Stevens VK, Coorevits PL, Caemaert JJ, Cambier DC, et al. Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients. BMC Musculoskelet Disord. 2011;12:65.
Pourtaheri S, Issa K, Lord E, Ajiboye R, Drysch A, Hwang K, et al. Paraspinal muscle atrophy after lumbar spine surgery. Orthopedics. 2016;39(2):e209–e214.
Putzier M, Hartwig T, Hoff EK, Streitparth F, Strube P. Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF – a prospective randomized clinical trial. Spine J. 2016;16:811–9.
Oosterhuis T, Costa LO, Maher CG, de Vet HC, van Tulder MW, Ostelo RW. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. 2014;3:Cd003007.
Choi G, Raiturker PP, Kim MJ, Chung DJ, Chae YS, Lee SH. The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery. 2005;57(4):764–72. discussion 764-772.
How to Cite
Copyright (c) 2021 Ela Kaplan, Pınar Kırıcı
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.