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.
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