Imaging Study Of Paraspinal Muscles In Patients With Single-segment Lumbar Disc Herniation

BackgroundSpinal degeneration can occur not only in the bone and disc but also in muscles.Atrophy of muscles and loss of gross volume are characteristic changes in the progression of degenerative diseases of the spine.Experts and scholars at home and abroad have studied the changes of paraspinal muscles in patients with degenerative lumbar spondylolisthesis and lumbar scoliosis.However,there are few studies on the correlation between paraspinal muscles and lumbar disc herniation.ObjectiveTo investigate the cross-sectional area of paraspinal muscles on both sides of the herniated lumbar intervertebral disc in patients with single-segment lumbar disc herniation and only the clinical symptoms of the herniated side.To observe the changes of these muscles and compare them with the control group,to analyze the relationship between paraspinal muscles and the disease,and to explore the role of paraspinal muscles in the occurrence and progress of the disease.MethodsFrom October 2016 to January 2019,patients with lumbar intervertebral disc herniation with unilateral symptoms who were treated in orthopaedics department of our hospital were selected.Inclusion criteria:1)single-level(only L4/5)disc herniation,lumbosacral and lower extremity radiation pain,pain located in the herniated side of the intervertebral disc,with a history of more than 6 months,complete clinical data;2)no previous history of lumbar surgery;3)no history of congenital spinal dysplasia,lumbar spondylolisthesis,spinal tumors,spinal tuberculosis,spinal infection and major trauma;4)no history of cerebrovascular disease,;5)All patients underwent lumbar MR examination(3.0T)in our hospital.The data were well preserved.Exclusion criteria:1)patients with two or more segments of lumbar disc herniation;2)symptoms of lumbar disc herniation after major trauma or intensive exercise;3)history of lumbar surgery;4)lumbar instability,spinal tumors,spinal tuberculosis;5)combined with cerebrovascular disease,heart disease or other congenital diseases,long-term incapacity to engage in manual workers;6)incomplete imaging data:7)A digestive disease that causes ascites or other space-occupying lesions to compress the rear muscles.The cross-sectional area of each muscle group of bilateral paraspinal muscles was measured by the self-contained area measuring tool of PACS system.The data were imported into SPSS 23.0 statistical software.The sum and ratio of cross-sectional area of left and right sides of each muscle group of paraspinal muscles were calculated by comparing the data of each experimental group with that of the control group.Independent sample t-test was performed,and if P<0.05,there was statistical significance.ResultsThere was no significant difference in age,sex,weight and other demographic data in the left symptomatic group.Compared with the control group,the cross-sectional area of the left and right sides of the paraspinal muscles in the experimental group decreased in varying degrees.Compared with the control group,the ratio of the cross-sectional area of the right and left sides of the paraspinal muscle groups in the experimental group,psoas major was significantly different,while the erector spine was different,and the multifidus had no significant difference.ConclusionsIn single segment(L4/5)patients with lumbar disc herniation,paraspinal muscles on the affected side atrophied significantly compared with those on the healthy side.In single segment(L4/5)patients with lumbar disc herniation,the degree of atrophy of paravertebral muscles was psoas major>erector spine>multifidus.