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PubMed1997

Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle.

STUDY DESIGN: This study investigated the changes in the lumbar muscles after posterior fusion of the lumbar spine and the potential correlation between muscular changes and the persistence of low back pain. OBJECTIVES: To evaluate prospectively the effect of the posterior approach to the spine on the lumbar erector spinae. SUMMARY OF BACKGROUND DATA: The posterior approach to the spine leads to considerable alteration of the erector spinae muscles. An eventual correlation between these changes and persisting pain or other clinical symptoms has not been investigated previously. METHODS: Seventy-five patients undergoing spondylosyndesis for different indications (43 patients) or a second operation for the removal of internal fixation (32 patients) were allotted to the study. In each patient, four biopsy specimens from the lumbar multifidus muscle were harvested; in 14 patients, biopsies were taken at both operations. Size and distribution of the fiber types (I, IIA, IIB, IIC) were determined, and pain scoring (visual analogue scale) and the presence of neurologic deficits were recorded. RESULTS: At the time of the first operation, 88% of the patients showed pathologic changes (altered internal structure, atrophy, type grouping) in one or more biopsies. Statistical analysis showed a correlation between both age and pain and type II (A + B) atrophy. After surgery, the patients showed significantly more biopsies with denervation signs than before surgery. No correlation could be made, however, between the intensity of pain before or after surgery and the relative number of biopsies with signs of denervation. CONCLUSIONS: Posterior surgery causes muscular alterations; however, no correlation with pain or other clinical symptoms could be established. Therefore, in the case of unsatisfactory results after surgery of the lumbar spine, reasons other than muscle damage caused by use of the posterior approach must be considered.

Adolescent↗
PubMed1997

Fiber transformations in multifidus muscle of young patients with idiopathic scoliosis.

STUDY DESIGN: In this study, the authors investigated the superficial multifidus muscle in patients with idiopathic scoliosis. During spinal fusion, biopsies were taken bilaterally at the apex of the curve, and at the upper and lower end vertebrae. OBJECTIVES: To analyze the muscular reactions in response to bracing in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The extent to which intervertebral mobility is restricted by an orthosis is still controversial. In addition, the effect of bracing on the erector spinae has not been investigated. METHODS: Of a total 30 patients, 11 had been treated with a corset for a year or more before surgery. Biopsies were investigated histochemically and the muscle fibers classified as Type I, IIA, IIB, or IIC (transitional fibers). The relative distribution of the fibers was calculated and their diameter was measured. RESULTS: In unbraced patients, a shift in the fiber distribution (from "slow" to "fast") was observed exclusively at the concave side of the apex. This shift was paralleled by an increased percentage of the intermediate Type IIC fiber (indicative of fiber transformation). In patients who always wore a corset, the relative amount of Type IIC fibers was increased, without preference for a specific location. CONCLUSIONS: Corset treatment elicits muscle fiber transformation processes at different levels along the scoliosis. This general reaction of the paraspinal muscles provides strong evidence against the existence of muscular disorders that are restricted to the area of the apex and are thus causing the scoliosis. As such, it must be assumed that the muscular changes in the apical region are secondary.

Adenosine Triphosphate↗
PubMed2003

Precision of a needle localization technic in the lumbosacral multifidus muscles for segmental specific needle electromyographic study: a cadaveric study.

The authors studied 14 cadavers to evaluate the claimed precision of needle placement into segment specific multifidus fascicles when using the "paraspinal mapping" electromyographic technic. Injection of acrylic dye was made according to landmarks proposed by Haig. The dissection showed 86.6 per cent of the injected dye in the correct fascicles. Only 1.4 per cent of the dye was lost. Spinous process level misidentification was the cause of the other 11.8 per cent incorrect injection. The authors expected that in living humans, in which the spinous processes are move identificable than embalmed cadavers, the precisions may be as high as 98.5 per cent. This remains to be studied in a further "in vivo" study.

Cadaver↗
PubMedDate not supplied

The EMG development of the longissimus and multifidus muscles after plugging the horizontal semicircular canals.

The effects of plugging both horizontal semicircular canals at the 5th postnatal day (P5) on the development of the EMG of two back muscles (the M. longissimus lateralis and the M. multifidus) were studied in rats between P5 and P46. The EMG was related to locomotion, grooming, and rearing of these rats. Special attention was paid to locomotor behavior. After this vestibular deprivation, the development of a consistent temporal relation between burst activity in the EMG of both Mm. longissimii laterales and the swing phase of one hind paw was retarded by about 3 days. The development of coupling of maximal activity in the M. longissimus lateralis to the swing phase of one of the hind paws was even more retarded. No differences were observed between normal and vestibularly deprived rats during the development of activity in the Mm. multifidi. Our results indicate that information from the horizontal semicircular canals is essential for dynamic postural development and probably, therefore, for motor development in general. Furthermore, lack of such information has effects on the fine tuning of back muscle activity during locomotion at least until P40.

Animals↗
PubMed1993

Spinal projections of cat primary afferent fibers innervating lumbar facet joints and multifidus muscle.

The spinal projections of small-caliber (presumably nociceptive) afferents arising from lumbar spinal joints and muscles were examined using anterograde transport of WGA-HRP. Injections of WGA-HRP into these structures gave rise to similar, rostro-caudally extensive patterns of spinal labeling indicating that many afferents innervating one facet joint or paraspinal muscle terminate bilaterally in laminae I-II, V-VIII, and X of the lumbar, sacral, and thoracic spinal cord. These diffuse patterns of terminal arborization are reminiscent of visceral input and contrast with the more restricted unilateral terminal fields reported for afferents innervating more distal hindlimb tissues.

Animals↗
PubMed1989

Connective tissue changes of the multifidus muscle in patients with lumbar disc herniation. An immunohistologic study of collagen types I and III and fibronectin.

The connective tissue components, Types I and III collagen fibronectin, were immunohistologically analyzed using their specific antibodies for localization and semiquantitative estimation in 24 patients (11 women and 13 men, all under 55 years of age) operated on for herniated lumbar intervertebral disc. Nine cadavers without known back problems (2 women, 7 men) served as controls. In controls, Type I collagen was present in the endo- and perimysial structures of the muscle, more conspiciously in the former. Type III collagen, together with fibronectin, were more abundant in the perimysium than in the endomysium. Thickening of these structures was not evident in the controls. In most patients Types I and III collagen and fibronectin distribution was similar to that of the controls. However, fibrotic changes of both and endo- and perimysial structures involved all Types I and III collagen and fibronectin in ten cases. In two patients an increase in Type I collagen staining intensity in the endomysium was recorded and thickening of the endomysial structures was observed in six patients. There were correlations with the severity of the connective tissue structural changes to atrophy of the muscle and furthermore to disability of the patient in the 1-year postoperative check-up. These findings suggest that if marked fibrosis of the muscle occurs, it can be a factor impairing recovery from the disease during the long-term postoperative course.

Adult↗
PubMed2002

Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues.

STUDY DESIGN: Electrophysiologic recordings were obtained from a lumbar paraspinal nerve or muscle in the anesthetized cat while electrically stimulating a paraspinal nerve or facet capsule in an adjacent lumbar segment. A variety of approaches were used to demonstrate the reflex nature of both the nerve and the muscle response. OBJECTIVE: The primary purpose of this study was to seek electrophysiologic evidence for the presence of intersegmental reflexes between adjacent lumbar vertebral segments. A second purpose of this study was to confirm a previous procedure used to evoke paraspinal reflexes. This previous work had shown that electrical stimulation of the L1-L2 facet joint capsule elicits electromyographic activity from multifidus muscle one to two vertebral segments caudal to the stimulated facet in a porcine preparation. SUMMARY OF BACKGROUND DATA: Biomechanical approaches have stressed the need for spinal stability to avoid conditions that could give rise to low back dysfunction. It seems reasonable to believe that reflex interactions between vertebral segments contribute to the sensorimotor integration of lumbar paraspinal tissues. It also seems reasonable to believe that alterations or abnormal elicitation of these reflexes could contribute to biomechanical changes associated with low back pain and paraspinal muscle spasm. METHODS: Experiments were performed on 23 alpha-chloralose anesthetized adult cats. In eight cats the L3, L4, and L5 medial branch from each dorsal ramus was exposed and placed on a bipolar hook electrode. In six cats the L4 medial branch was stimulated and a compound action potential was recorded from the L3 medial branch. In three of the six cats the L5 medial branch was stimulated and a compound action potential was recorded from the L3 medial branch. In one cat the L4 medial branch was stimulated and a compound action potential was recorded from the L5 medial branch. In one cat the L3 medial branch was stimulated and a compound action potential was recorded from the L5 medial branch. At the end of each protocol the medial branch was cut just proximal to the stimulating electrode to confirm that the compound action potential was reflexive in nature and not initiated by volume conduction. In 15 cats three approaches were used to confirm that multifidus electromyographic activity evoked by electrical stimulation of a lumbar facet capsule was reflexive in nature: 1) by anesthetizing the site of the sensory endings, i.e., the facet capsule, 2) by injecting lidocaine intrathecally to block neural conduction centrally, i.e., within the spinal canal, or 3) by cutting the afferent pathway, i.e., the medial branch of the dorsal ramus. RESULTS: Electrical stimulation of the medial branch of the dorsal ramus innervating the medial-most lumbar paraspinal tissues evoked a compound action potential in the medial branch innervating the medial-most paraspinal tissues one and two segments away. Stimulating voltages between 2 and 70 V were necessary to evoke the compound action potential. Each compound action potential was reflexive in nature because cutting the lumbar medial branch proximal to its contact with the stimulating electrode abolished each compound action potential. The conduction velocity of the reflex ranged from 3.5 to 6.1 m/sec. Electrical stimulation of a lumbar facet capsule evoked lumbar multifidus muscle electromyographic activity. However, injecting lidocaine intrathecally or transecting the medial branch of the dorsal ramus had no effect on electromyographic activity. Injecting lidocaine into the facet or into the multifidus muscle around the facet joint (near the stimulating electrode) significantly decreased the magnitude of the multifidus electromyography. CONCLUSION: These results indicate that afferent impulses conveyed by the medial branch of the dorsal ramus reflexly altered efferent activity to an adjacent lumbar segment. This intersegmental paraspinal reflex may span at least one or two vertebral segments. The data suggest that electrical stimulation of the facet joint capsule may not have reflexly elicited multifidus activity because neither chemical interruption (intrathecal lidocaine) nor physical interruption (nerve transection) of the presumed reflex pathway diminished or abolished the electromyographic response. Volume conduction of the stimulating currents likely elicited multifidus activity during electrical stimulation of the facet capsule. When using electrical stimulation of neural paraspinal tissues to evoke reflex muscle activity, appropriate control experiments must be performed to clearly demonstrate the reflexive nature of the response.

Action Potentials↗
PubMed2000

CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects.

Increasing documentation on the size and appearance of muscles in the lumbar spine of low back pain (LBP) patients is available in the literature. However, a comparative study between unoperated chronic low back pain (CLBP) patients and matched (age, gender, physical activity, height and weight) healthy controls with regard to muscle cross-sectional area (CSA) and the amount of fat deposits at different levels has never been undertaken. Moreover, since a recent focus in the physiotherapy management of patients with LBP has been the specific training of the stabilizing muscles, there is a need for quantifying and qualifying the multifidus. A comparative study between unoperated CLBP patients and matched control subjects was conducted. Twenty-three healthy volunteers and 32 patients were studied. The muscle and fat CSAs were derived from standard computed tomography (CT) images at three different levels, using computerized image analysis techniques. The muscles studied were: the total paraspinal muscle mass, the isolated multifidus and the psoas. The results showed that only the CSA of the multifidus and only at the lowest level (lower end-plate of L4) was found to be statistically smaller in LBP patients. As regards amount of fat, in none of the three studied muscles was a significant difference found between the two groups. An aetiological relationship between atrophy of the multifidus and the occurrence of LBP can not be ruled out as a possible explanation. Alternatively, atrophy may be the consequence of LBP: after the onset of pain and possible long-loop inhibition of the multifidus a combination of reflex inhibition and substitution patterns of the trunk muscles may work together and could cause a selective atrophy of the multifidus. Since this muscle is considered important for lumbar segmental stability, the phenomenon of atrophy may be a reason for the high recurrence rate of LBP.

Adult↗
PubMed2001

Comparative histochemical composition of muscle fibres in a pre- and a postvertebral muscle of the cervical spine.

References to histochemistry are extensive for human limb muscles but occur less frequently in relation to vertebral muscle. Most vertebral muscle literature has been concerned with muscle fibre characteristics in the lumbar and thoracic spine, due in large part to the incidence of low back pain and idiopathic scoliosis. However few studies have investigated the histochemical composition of neck muscles in humans: and, to our knowledge, no previous study has examined the antagonistic longus colli and multifidus muscle pair. In addition, while age-related segmental degeneration is most prominent between C5 and C7, it is not known whether these osteoligamentous changes are paralleled by changes in muscle fibre ratio. Tissue blocks comprising muscle and bone from C5-C7 segments were harvested at autopsy from 16 subjects with ages ranging from 4 to 77 years. The prevertebral longus colli and postvertebral multifidus muscle pairs were randomly selected from one or other side in each subject. The tissue was frozen, sectioned and histochemically stained for myofibrillar adenosine triphosphatase. Analysis of muscle fibre types was performed by light microscopy. Wilcoxon paired t-tests were used to ascertain whether intramuscular and intermuscular differences in fibre composition were significant. In addition, correlation and regression analyses were used to determine whether fibre type proportions changed in either muscle with increasing age. The present study has revealed histochemical differences between longus colli and multifidus at the level of the C5-C7 vertebral segments. Multifidus comprises a significantly greater proportion of type I than type II fibres. Longus colli comprises a significantly greater proportion of type II fibres than multifidus. Further there were no changes in fibre type proportion in either muscle with increasing age. These observations suggest that longus colli responds equally to postural and phasic demands, whereas multifidus is predominantly postural. Also it would appear that age-related structural alterations in lower cervical segments are not paralleled by changes in muscle fibre ratio.

Adenosine Triphosphatases↗
PubMed1998

The ligamento-muscular stabilizing system of the spine.

STUDY DESIGN: Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. OBJECTIVES: To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. METHODS: The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. RESULTS: Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. CONCLUSIONS: Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.

Animals↗
PubMed1996

Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects.

OBJECTIVE AND DESIGN: To investigate the reliability (within-day and between-days) of measurements of electromyographic (EMG) power spectral values in measurement of the fatigue rate of the back muscles. METHODS: Twelve healthy male subjects were tested in the unsupported trunk holding position for 60 seconds. Two trials were performed on each of two separate sessions 3 days apart. Surface recording electrodes were placed over the iliocostalis lumborum and multifidus and a branched electrode technique was used to decrease cross-talk. OUTCOME MEASURES: Median frequency (MF) was extracted from the EMG signals by fast Fourier transform. Initial MF and the MF slope over time were computed from linear regression analysis. The reliability of the initial MF and the MF slope of the iliocostalis lumborum and multifidus was examined by Pearson's product moment correlation coefficients (Pearson's r), paired t tests, and a one-way analysis of variance (ANOVA) from which intrasubject coefficients of variation (CVintra) and intraclass correlation coefficients (ICC) were derived. RESULTS: For the initial MF, within-day and between-days reliability of the iliocostalis lumborum and multifidus were good (Pearson's r = .79-.94 nonsignificant paired t test, CVintra = 6.5% to 8.5%, ICC = .79-.93). The MF slope showed moderate variability for the iliocostalis lumborum (Pearson's r = .39-.55, nonsignificant paired t test, CVintra = 33.0% to 48.7%, ICC = .37-.56) while better reliability was found for the multifidus (Pearson's r = .77-.87, nonsignificant paired t test, CVintra = 25.8% to 27.5%, ICC = .78-.82). CONCLUSION: The present study indicated that the trunk holding test with the use of EMG power spectral analysis can be a reliable method to measure the fatigue rate of the back muscles if adequate measures are employed to minimize cross-talk. The better reliability of monitoring the fatigue rate of the multifidus may lead to its future use as a clinical measure.

Adult↗
PubMed1999

Back and hip extensor muscle function during therapeutic exercises.

BACKGROUND: Therapeutic exercises are widely used in the treatment of low back problems. Clinical knowledge about targeting the load in these exercises, however, is insufficient. This study assessed the L2 and L5 level paraspinal and gluteus maximus muscle activities in different therapeutic exercises. Intramuscular and surface electromyography (EMG) measurements were obtained to study whether surface EMG measurements can be used in the assessment of multifidus muscle function. METHODS: Eleven healthy subjects (5 men, 6 women) 21 to 38 years of age volunteered for the study. The subjects performed 18 different therapeutic exercises. During the exercises paraspinal EMG was recorded using fine wire and surface electrodes. The normalized peak and average muscle EMG activities (percentage of amplitude in maximal voluntary contraction [MVC]) during each task were determined. RESULTS: The correlations between the average intramuscular and surface activities of the normalized EMG (% of MVC) at the L2 and L5 levels were .928 and .950, respectively. The peak and average EMG amplitudes of the exercises were below 50% and 25% of MVC, respectively. At the L5 level, the multifidus peak and average EMG amplitudes (% MVC) were higher in women than in men, whereas no significant difference was found at the L2 level. In women, the normalized multifidus EMG amplitude was higher at the L5 level than at the L2 level, whereas no significant difference was found in men. In both sexes, the normalized EMG amplitude was higher in the multifidus than in the longissimus muscle. CONCLUSION: Surface EMG measurements may be used in the assessment of multifidus muscle function. Simple therapeutic exercises are effective in activating the lumbar paraspinal muscles.

Adult↗
PubMed2001

Effects of eccentric exercise on trunk extensor torque and lumbar paraspinal EMG.

PURPOSE: Little is known about the effects of eccentric contractions on the function of the lumbar paraspinal muscles. The purpose of this study was to determine the effects of a single bout of eccentric contractions using the trunk extensor muscles on torque and lumbar paraspinal electromyographic (EMG) parameters. METHODS: Twenty healthy men between the ages of 18 and 49 yr participated in the study. Subjects performed a single bout of 50 maximal voluntary concentric (N = 10) or eccentric (N = 10) trunk extension movements while surface EMG signals were recorded from the multifidus and iliocostalis lumborum muscles. A series of isometric contractions were performed both before the exercise protocol and at five additional time points over the following 7 d. RESULTS: During the exercise protocol, peak torque decreased 30% and 24% in the eccentric and concentric groups, respectively, whereas no change occurred in EMG root-mean-square (RMS). There were no group differences in peak torque generation at any of the postexercise protocol time points. Compared with the preexercise protocol values, multifidus EMG was elevated 27% immediately post and 15 min post in the eccentric group. Similarly, compared with the concentric group, multifidus EMG in the eccentric group was increased 34%, 40%, and 25% immediately post, 15 min post, and 1 d after the exercise protocol, respectively. CONCLUSION: Eccentric contractions using the trunk extensor muscles result in higher levels of multifidus EMG activity to produce a given level of torque. This reduction in neuromuscular efficiency persisted for one day with recovery to baseline levels by the third day. Contrary to studies using other muscle groups, no sustained alteration in muscle function was observed.

Adolescent↗