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The Study of Fat Infiltration Ratio in Lumbar Paraspinal Muscle of Patient with Herniated Intervertebral Lumbar Disc

요추간판 수핵 탈출증 환자의 요부 척추 주위근 내 지방침윤 비율에 관한 연구

  • Kong, Bong-Jun (Graduate school of physical therapy, Daegu University) ;
  • Lee, Jung-Ho (Graduate school of physical therapy, Daegu University) ;
  • Yong, Min-Sik (Graduate school of physical therapy, Daegu University) ;
  • Kim, Jin-Sang (Department of physical therapy, Daegu University)
  • 공봉준 (대구대학교 물리치료학과 대학원) ;
  • 이중호 (대구대학교 물리치료학과 대학원) ;
  • 용민식 (대구대학교 물리치료학과 대학원) ;
  • 김진상 (대구대학교 재활과학대학 물리치료학과)
  • Received : 2012.08.20
  • Accepted : 2012.11.08
  • Published : 2012.11.30

Abstract

The purpose of this study is to find the relationship between lumber Herniated Nuclesus Pulposus of specific part and fat infiltration in paraspinal muscle. Also we intended to find the relationship between Body Mass Index(BMI) and fat infiltration ratio in the lumber paraspinal muscle based on the sexes of patients. We conducted this study of patients who visited our hospital from May, 2010 to May, 2012. The subjects are composed of 40 patients(20 females and 20 males), who are 30 to 50 years old suffering from severe lumber herniated nuclesus pulposus, who had or were going to have operation treatment. BMI is measured through anthropometry of each patient and fat infiltration inside the muscle is estimated by measuring the cross section area of lumbar paraspinal muscle from mid-cross section of disc(L2-S1) and fat infiltration ratio. The data of this study are analyzed by independent t-test to figure out the difference of fat infiltration between male and female, and by paired sample T-test after getting mean and standard deviation to find the changes of fat infiltration of lumbar on each level. Also correlation analysis is done by setting age as a control variable to find the correlation between BMI and fat infiltration of the whole lumbar. As a result, we could get only the meaningful difference between the sexes on upper lumber part(L2-L3) while we couldn't find any significant difference in the rest of lumbar(L3-S1). Besides, the changes of fat infiltration ratio on each lumbar level increased rapidly from lumbar 3,4 to lumbar 4,5. We also found that there is no correlation between fat infiltration ratio of lumbar paraspinal muscle(L2-S1) and BMI.

본 연구의 목적은 특정 부위의 요부 추간판 탈출과 척추 주위 근 내 지방침윤과의 관계를 알아보기 위함이다. 아울러 환자의 체질량지수(BMI)와 성별에 따른 요부 주위 근의 지방 침윤율의 관계를 알아보고자 하였다. 2010년 5월부터 2012년 5월까지 내원한 환자를 대상으로 연구를 진행했다. 연구 대상자는 30~50세 사이의 중증 추간판 탈출증 환자로 수술적 요법을 시행할 또는 실시한 환자 남녀 40인으로 구성하였고, 측정 및 방법은 환자의 신체계측을 통해 BMI를 산출하였으며, L2-S1까지 디스크 중앙 횡단면에서 요부 주위 근의 단면적과 지방 침윤 면적을 측정하여 근육 내 지방의 침윤율을 계산하였다. 연구 분석은 지방침윤의 남녀 차이를 알아보기 위해 독립표본 T 검증을 시행하였고, 요추 레벨 간 지방침윤의 변화를 알아보기 위해 평균과 표준편차를 산출하여 대응표본 T 검증을 하였다. 또한, BMI와 요부 전체 지방 침윤율과의 상관관계를 알아보기 위해 나이를 제어변수로 한 상관분석을 시행하였다. 이러한 결과로 지방침윤의 남녀 차이는 상위요부(L2-L3)에서 유의한 차이가 있었을 뿐, 나머지 요부(L3-S1)에서는 유의한 차이가 없었으며, 요부 레벨 간 지방침윤율의 변화는 요추3, 4에서 요추4, 5번에서 많이 증가하였다. 또한, 요부(L2-S1)주위 근의 지방 침윤과 체질량지수와는 상관관계가 없음을 확인하였다.

Keywords

References

  1. Aure O, Nilsen J, Vasseljen O., "Manual therapy and exercise therapy in patients with chronic low back pain: A randomized, controlled trial with 1-year follow-up", Spine, 28:525-532, 2003.
  2. Suni J, Rinne M, Natri A, Pasanen M, Parkkari J, Alaranta H., "Control of the lumbar neutral zone decreases low back pain and improves selfevaluated work ability", Spine, 31:E611-E620, 2006. https://doi.org/10.1097/01.brs.0000231701.76452.05
  3. R. Parkkola, U. Ryto.koski, and M. Kormano, "Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects", Spine, Vol.18, No.7, pp.830-836, 1993. https://doi.org/10.1097/00007632-199306000-00004
  4. Deyo, RA,, Walsh NE,, & Matin DC, "A controlled trial of transcutaneous electrical nerve stimulation(TENS) and exercise for chronic low back pain", New England Journal of Medicine, Vol. 322, No. 23, pp. 1627-1634, 1990. https://doi.org/10.1056/NEJM199006073222303
  5. J. G. Reid, P. A. Costigan, and W. Comrie W., "Prediction of trunk muscle areas and moment arms by use of anthropometric measures," Spine, Vol.12, No.3, pp.273-275, 1987. https://doi.org/10.1097/00007632-198704000-00015
  6. Kjaer P, Bendix T, Sorensen J, Korsholm L, Leboeuf-Yde C., "Are MRI defined fat infiltrations in the multifidus muscles associated with low back pain?", BMC Medicine, 5:2, 2007. https://doi.org/10.1186/1741-7015-5-2
  7. Fanuele JC, Abdu WA, Hanscom B, Weinstein JN, "Association between obesity and functional status in patients with spine disease", Spine, 27:306-312, 2002. https://doi.org/10.1097/00007632-200202010-00021
  8. Hangai M, Kaneoka K, Kuno S, Hinotsu S, Sakane M, Mamizuka N, Sakai S, Ochiai N., "Factors associated with lumbar intervertebral disc degeneration in the elderly", Spine, 8(5):732-40, 2008. https://doi.org/10.1016/j.spinee.2007.07.392
  9. Kostova V, Koleva M., "Back disorders (low back pain, cervicobrachial and lumbosacral radicular syndromes) and some related risk factors", J Neurol Sci, 192:17-25, 2001. https://doi.org/10.1016/S0022-510X(01)00585-8
  10. Mellin G, Harkapaa K, Vanharanta H, Hupli M, Heinonen R, Jarvikoski A., "Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain", Spine, 18(7):825-829, 1993. https://doi.org/10.1097/00007632-199306000-00003
  11. Janke AE, Collins A, Kozak AT, "Overview of the relationship between pain and obesity: What do we know? Where do we go next?", Journal of Rehabil Res and Dev, 44:245-262, 2007. https://doi.org/10.1682/JRRD.2006.06.0060
  12. Buckwalter JA, "Maintaining and restoring mobility in middle and old age: the importance of the soft tissues", Instr Course Lect, 46:459-69, 1997.
  13. Tsuritani I, Honda R, Noborisaka Y, Ishida M, Ishizaki M, Yamada Y, "Impact of obesity on musculoskeletal pain and difficulty of daily movements in Japanese middle-aged women", Maturitas, 42(1):23-30, 2002. https://doi.org/10.1016/S0378-5122(02)00025-7
  14. Mannion AF, "Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain", J Electromyogr Kinesiol, 9:363-377, 1999. https://doi.org/10.1016/S1050-6411(99)00010-3
  15. Mannion AF, Kaser L, Weber E, Rhyner A, Dvorak J, Muntener M, "Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back patients", Eur Spine J, 9:273-281, 2000. https://doi.org/10.1007/s005860000189
  16. Campbell WW, Vasconcelos O, Laine FJ, "Focal atrophy of the multifidus muscle in lumbosacral radiculopathy", Muscle Nerve, 21:1350-1353, 1998. https://doi.org/10.1002/(SICI)1097-4598(199810)21:10<1350::AID-MUS21>3.0.CO;2-4
  17. Dangaria TR, Naesh O., "Changes in cross-sectional area of psoas major muscle in unilateral sciatica caused by disc herniation", Spine, 23:928-931, 1998. https://doi.org/10.1097/00007632-199804150-00016
  18. Yoshihara K, Shirai Y, Nakayama Y, Uesaka S, "Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation", Spine, 26:622-626, 2001. https://doi.org/10.1097/00007632-200103150-00012
  19. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O, "Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises", Spine, 29:3-8, 2004. https://doi.org/10.1097/01.BRS.0000103946.26548.EB
  20. Le Huec JC, Mathews H, Basso Y, Aunoble S, Hoste D, Bley B, Friesem T, "Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up", Orthop Clin North Am, 36:315-322, 2005. https://doi.org/10.1016/j.ocl.2005.02.001
  21. Barker KL, Shamley DR, Jackson D, "Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability", Spine, 29:E515-E519, 2004. https://doi.org/10.1097/01.brs.0000144405.11661.eb
  22. Storheim K, Holm I, Gunderson R, Brox JI, Bo K, "The effect of comprehensive group training on cross-sectional area, density, and strength of paraspinal muscles in patients sick-listed for subacute low back pain", J Spinal Disord Tech, 16:271-279, 2003. https://doi.org/10.1097/00024720-200306000-00008
  23. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ, "CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects", Eur Spine J, 9:266-272, 2000. https://doi.org/10.1007/s005860000190
  24. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH, "Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain", Spine, 19:165-172, 1994. https://doi.org/10.1097/00007632-199401001-00009
  25. McLoughlin RF, D'Arcy EM, Brittain MM, Fitzgerald O, Masterson JB, "The significance of fat and muscle areas in the lumbar paraspinal space: a CT study", J Comput Assist Tomogr, 18:275-278, 1994. https://doi.org/10.1097/00004728-199403000-00021
  26. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA, "Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study", J Gerontol A Biol Sci Med Sci, 60:882-887, 2005. https://doi.org/10.1093/gerona/60.7.882
  27. Gibbons LE, Latikka P, Videman T, Manninen H, Battie MC, "The association of trunk muscle cross-sectional area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men", J Spinal Disord, 10:398-403, 1997.
  28. Erkintalo MO, Salminen JJ, Alanen AM, Paajanen HE, Kormano MJ, "Development of degenerative changes in the lumbar intervertebral disk: results of a prospective MR imaging study in adolescents with and without low-back pain", Radiology, 196:529-533, 1995. https://doi.org/10.1148/radiology.196.2.7617872
  29. Parkkola R, Rytokoski U, Kormano M, "Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects", Spine, 18:830-836. 1993, https://doi.org/10.1097/00007632-199306000-00004
  30. Peltonen JE, Taimela S, Erkintalo M, Salminen JJ, Oksanen A, Kujala UM, "Back extensor and psoas muscle cross-sectional area, prior physical training, and trunk muscle strength. a longitudinal study in adolescent girls", Eur J Appl Physiol, 77:66-71, 1998.
  31. Jinkins JR, "Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration", JBR-BTR, 86:226-230, 2003.
  32. Mooney V, Gulick J, Perlman M, Levy D, Pozos R, Leggett S, Resnick D, "Relationships between myoelectric activity, strength, and MRI of lumbar extensor muscles in back pain patients and normal subjects", J Spinal Disord, 10:348-356, 1997.
  33. Gibbons LE, Videman T, Battie MC, "Isokinetic and psychophysical lifting strength, static back muscle endurance, and magnetic resonance imaging of the paraspinal muscles as predictors of low back pain in men", Scand J Rehabil Med, 29:187-191, 1997.
  34. P. R. Dupuis, K. Yong-Hing, J. D. Cassidy, and W. H. Kirkaldy-Willis, "Radiologic diagnosis of degenerative lumbar spinal instability", Spine, Vol.10, No.3, pp.262-276, 1985. https://doi.org/10.1097/00007632-198504000-00015
  35. Michael D. Freeman, PhD et al, "The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review", PM&R, vol.2, 142-146, 2010. https://doi.org/10.1016/j.pmrj.2009.11.006
  36. L. A. Danneels, P. L. Coorevits, A. M. Colls, G.G. Vanderstraeten, D. C. Cambier, E. E. Witvrouw, and C. H. De, "Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain", Eur Spine J, Vol.11, No.1, pp.13-19, 2002. https://doi.org/10.1007/s005860100314
  37. D. F. Kader, D. Wardlaw, and F. W. Smith, "Correlation between the MRI changes in the lumbar multifidus muscle and leg pain", Clin Radiol, Vol.55, No.2, pp.145-149, 2000. https://doi.org/10.1053/crad.1999.0340
  38. Jeong Sook Nam, "An alysis of the Relationship between Body Mass Index(BMI) and Medical Services Use", Graduate School of Public Health Yonsei University, 2010.
  39. Neil, N., & Sinnott, P. L., "Variation in balance and body sway in middle adults", Spine, 16: 325-30. 1991. https://doi.org/10.1097/00007632-199103000-00012
  40. Rodacki AL, Fowler NE, Provensi CL, et al., "Body mass as a factor in stature change", Clin Biomech (Bristol, Avon), 20:799-805, 2005. https://doi.org/10.1016/j.clinbiomech.2005.04.005
  41. Yar T., "Spinal shrinkage as a measure of spinal loading in male Saudi university students and its relationship with body mass index", Saudi Med J, 29:1453-7, 2008.
  42. Fabris de Souza SA, Faintuch J, Valezi AC, et al., "Postural changes in morbidly obese patients", Obes Surg, 15:1013-6, 2005. https://doi.org/10.1381/0960892054621224
  43. Gilleard W, Smith T., "Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion", Int J Obes (Lond), 31:267-71, 2007. https://doi.org/10.1038/sj.ijo.0803430
  44. Kim hee jung, jo jung ho et al., "The Relationships between Health-related Physical Fitness, Body Composition, and Metabolic Indices in College Females", The Korea Journal of Sports Science, vol.14, no.2, pp. 565-579, 2005.
  45. Parkkola R, Kormano M, "Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass", J Spinal Disord, 5:86-92, 1992. https://doi.org/10.1097/00002517-199203000-00011
  46. Dennis S. Meredith, MD et al., "Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy", The Spine Journal, 10 575-580, 2010. https://doi.org/10.1016/j.spinee.2010.02.021
  47. Kim JM, Lee SH, Ahn Y, et al., "Recurrence after successful percutaneous endoscopic lumbar discectomy", Minim Invasive Neurosurg, 50:82-5, 2007. https://doi.org/10.1055/s-2007-982504