Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis

Tahere Seyedhoseinpoor; Mohammad Taghipour; Mehdi Dadgoo; Mohammad Ali Sanjari; Ismail Ebrahimi Takamjani; Anoshirvan Kazemnejad; Yasamin Khoshamooz; Julie Hides

doi:10.1016/j.spinee.2021.10.018

Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis

Spine J. 2022 Apr;22(4):660-676. doi: 10.1016/j.spinee.2021.10.018. Epub 2021 Oct 27.

Authors

Tahere Seyedhoseinpoor¹, Mohammad Taghipour², Mehdi Dadgoo¹, Mohammad Ali Sanjari³, Ismail Ebrahimi Takamjani¹, Anoshirvan Kazemnejad⁴, Yasamin Khoshamooz⁵, Julie Hides⁶

Affiliations

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. Electronic address: taghipour@mubabol.ac.ir.
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.

PMID: 34718177
DOI: 10.1016/j.spinee.2021.10.018

Abstract

Background context: Previous 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.

Purpose: The 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/setting: Systematic review with meta-analysis.

Patient sample: A patient sample was not required OUTCOME MEASURES: This review did not have outcome measures.

Methods: PubMed, 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.

Results: Results 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.

Conclusions: People 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.

Keywords: Cross-sectional area; Fat infiltration; Low back pain; Morphology; Muscle atrophy; Muscle composition.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Humans
Low Back Pain* / diagnostic imaging
Lumbar Vertebrae / diagnostic imaging
Lumbosacral Region
Magnetic Resonance Imaging
Paraspinal Muscles / diagnostic imaging