Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis |
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| Institution: | 1. Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran;2. Mobility Impairment Research Center, Health Institute, Babol University of Medical Sciences, Babol, Iran;3. Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran;4. Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran;5. Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran;6. School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia;1. Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Osaka 569-8686, Japan;2. Department of Anatomy and Cell Biology, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Osaka 569-8686, Japan;1. Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan;2. Department of Orthopedics, Shikoku Medical Center for Children and Adults, 2-1-1 Senyu-cho, Zentsuji-shi, Kagawa 765-8507, Japan;3. Department of Orthopedics, National Hospital Organization Kochi Hospital, 1-2-25, Asakuranishimachi, Kochi 780-8077, Japan;4. Department of Rehabilitation, Tokushima University Graduate School. 3-18-15, Kuramoto, Tokushima 770-8503, Japan;1. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;2. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan;3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan;4. Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan;5. Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan;6. Program of Artificial Intelligence and Information Security, Fu Jen Catholic University, New Taipei City, Taiwan;1. Department of Orthopaedic Surgery – Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA;2. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA;1. Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden;2. Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden;3. The Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario;4. Imperial College Healthcare, NHS Trust Charing Cross Hospital, W6 8RF, London, United Kingdom;5. National University Health Systems, Juronghealth Campus, Singapore;6. Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada;7. University of Calgary, Foothills Medical Centre, Calgary, AB, Canada;8. Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada;9. Department of Surgery, Dalhousie University, Halifax, NS, Canada;10. Division of Orthopaedics, Department of Surgery, Western University /London Health Sciences Centre; Lawson Health Research Institute /London Health Sciences Centre, London, ON, Canada;11. Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, NB, Canada;12. University of Toronto, Toronto, ON, Canada;13. Combined Neurosurgical & Orthopaedic Spine Program, Vancouver General Hospital and the University of British Columbia, Vancouver, BC, Canada;14. J. Bernard Gosevitz Chair in Arthritis Resear ch at UHN, Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University Health Network (UHN), Toronto, ON, Canada;15. Professor of Surgery, University of Toronto, Toronto, ON, Canada;1. Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA;2. Carle Neuroscience Institute, Urbana, IL, USA |
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| Abstract: | BACKGROUND CONTEXTPrevious studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles.PURPOSEThe primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP.STUDY DESIGN/SETTINGSystematic review with meta-analysis.PATIENT SAMPLEA patient sample was not requiredOUTCOME MEASURESThis review did not have outcome measures.METHODSPubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis.RESULTSResults showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles.CONCLUSIONSPeople with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies. |
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