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      Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis


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          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.


          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.


          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.


          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

          Electronic supplementary material

          The online version of this article (10.1186/s12891-018-2266-5) contains supplementary material, which is available to authorized users.

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          Most cited references52

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          Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects.

          Previous studies have provided evidence of multifidus muscle atrophy in people with low back pain (LBP). In cases of acute LBP, these studies have shown that the pattern of atrophy is both vertebral level and side specific. For chronic LBP, there are conflicting reports about the extent and location of muscle atrophy. The purpose of this study was to compare chronic LBP patients and asymptomatic subjects on measures of multifidus size (cross-sectional area; CSA) and symmetry (proportional difference of relatively larger side to smaller side). Data were obtained from 40 asymptomatic subjects without a prior history of LBP (13 females, 27 males), and a retrospective audit was undertaken of records from 50 chronic low back pain patients (27 females, 23 males) presenting to a back pain clinic. Results of the analysis showed that chronic LBP patients had significantly smaller multifidus CSAs than asymptomatic subjects at the lowest two vertebral levels. Males were found to have significantly larger multifidus CSAs than females at all vertebral levels except L5, the most common symptomatic level as determined by manual examination. The greatest asymmetry between sides was seen at the L5 vertebral level in patients with unilateral pain presentations. The smaller multifidus CSA was ipsilateral to the reported side of pain in all cases. The results of this study support previous findings that the pattern of multifidus muscle atrophy in chronic LBP patients is localized rather than generalized. Furthermore, between side asymmetry may be seen in chronic LBP patients presenting with a unilateral pain distribution.
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            The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle.

            Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F=29.1, p=0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F=6.6, p=0.02). This result was not present at other vertebral levels (p>0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.
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              Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis.

              Functional ankle instability (FAI) has been associated with impaired sensorimotor function; however individual studies have produced conflicting results. In an attempt to reduce this ambiguity, a systematic review with meta-analysis was undertaken to determine which sensorimotor deficits exist with FAI. Fifty-three studies assessing sensorimotor factors in subjects with FAI were included from 465 identified articles. Studies were rated for methodological quality and data were pooled for peroneal reaction time, joint position sense, and postural sway during single-leg stance and time to stabilisation from a single-leg jump. Data on joint movement sense were unable to be pooled. When subjects with unstable ankles were compared to healthy controls, sensorimotor impairments were demonstrated for passive joint position sense (mean difference (MD)=0.7 degrees , 95% confidence interval (CI): 0.2-1.2 degrees , p=0.004), active joint position sense (MD=0.6 degrees , 95% CI: 0.2-1.0 degrees , p=0.002), postural sway in single-leg stance (standardised MD (SMD)=0.6, 95% CI: 0.2-1.0, p=0.002), the star excursion balance test (SMD=0.4, 95% CI: 0.1-0.7, p=0.009), and time to stabilisation from a single-leg jump in a medio-lateral (MD=0.6 ms, 95% CI: 0.4-0.8, p<0.0001) and an antero-posterior direction (MD=0.7 ms, 95% CI: 0.4-1.0, p<0.0001). Peroneal reaction time was not affected. Sensorimotor deficits occur for joint position sense and postural control in subjects with FAI. Deficits in peroneal muscle reaction time following perturbation are not evident. Copyright (c) 2009 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

                Author and article information

                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                27 September 2018
                27 September 2018
                : 19
                [1 ]ISNI 0000 0004 0436 6763, GRID grid.1025.6, School of Health Professions, , Murdoch University, ; 90 South Street, Murdoch, Western Australia 6150 Australia
                [2 ]ISNI 0000 0001 0728 0170, GRID grid.10825.3e, Department of Sports Science and Clinical Biomechanics, , University of Southern Denmark, ; Campusvej 55, 5230, Odense M, DK Denmark
                [3 ]ISNI 0000 0004 0587 0347, GRID grid.459623.f, Spine Centre of Southern Denmark, ; Ostre Hougvej 55, 5500 Middelfart, DK Denmark
                [4 ]ISNI 0000 0004 0402 6080, GRID grid.420064.4, Nordic Institute of Chiropractic and Clinical Biomechanics, ; Campusvej 55, 5230 Odense M, DK Denmark
                [5 ]Department of Diagnostic Imaging, Regional Hospital Silkeborg, Falkevej 1-3, 8600 Silkeborg, DK Denmark
                [6 ]ISNI 0000 0004 0402 6152, GRID grid.266820.8, Faculty of Kinesiology, , University of New Brunswick, ; 3 Bailey Drive, Fredericton, New Brunswick E3B 5A3 Canada
                [7 ]ISNI 0000 0004 0436 6763, GRID grid.1025.6, School of Psychology and Exercise Science, , Murdoch University, ; 90 South Street, Murdoch, Western Australia 6150 Australia
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/100010970, Chiropractic and Osteopathic College of Australasia;
                Research Article
                Custom metadata
                © The Author(s) 2018

                lumbar spine,paraspinal muscle,disc herniation,radiculopathy,fat infiltration,canal stenosis,facet arthrosis


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