| 제목 |
Lumbar paraspinal muscle morphometry in patients with hemiplegia |
| 소속 |
CHA Bundang Medical Center, CHA University School of Medicine, Department of Rehabilitation Medicine1, CHA University, Rehabilitation and Regeneration Research Center2 |
| 저자 |
Wookyung Park1*, Geonho Yoon1, Mi Ri Suh1,2, Jong Moon Kim1,2, MinYoung Kim1,2, Kyunghoon Min1,2† |
Objective:
Patients with hemiplegia usually have impaired trunk control. Trunk balance influences the selective movements of upper and lower limbs. Loss of trunk control results in a negative influence on the posture and functional activities. Spinal muscles are considered to be one of the spinal stabilizing systems with neural control unit and spinal column. Although the causal link between lumbar muscle morphology and low back pain is not clear, there are several studies on paraspinal muscle morphology in patients with low back pain (LBP). Paraspinal muscles are significantly smaller in patients with chronic LBP. In stroke, there are several changes in the muscles, such as decreased muscle mass and decreased muscle fiber length. This study aims to identify the asymmetry of paraspinal muscles using functional cross-sectional areas on magnetic resonance imaging (MRI) in patients with hemiplegia.
Methods:
The medical records and lumbar MRI of subjects with hemiplegia who visited hospital between April 1, 2013 and May 1, 2018 were reviewed. Demographics and clinical features were acquired with etiology of hemiplegia. Inclusion criteria were history of hemiplegia and lumbar MRI performed after stroke. Subjects were excluded if they were quadriplegia or did not have any symptoms of weakness. Total cross-sectional area (CSA) and functional cross-sectional area (FCSA), defined as fat-free muscle mass, measurements of the multifidus muscle and the erector spinae muscle at L4-L5 level, bilaterally, were directly obtained for each subject using ImageJ (Figure, version 1.52, National Institutes of Health, Bethesda, Maryland). Independent t-test and Mann-whitney test were used to compare the parameters between the affected and unaffected sides. Differences were considered significant when the p-value was less than 0.05.
Results:
Characteristics of subjects are described in Table 1. There were no significant differences in CSA of multifidus and erector spinae muscles between affected side and unaffected side. However, FCSA of the affected side of multifidus and erector spinae muscles was significantly small as compared with the unaffected side (p=0.049 and p=0.036, respectively). FCSA/CSA of multifidus muscle was significantly low as compared with the unaffected side (p=0.006) but not in erector spinae muscle. The results are summarized in the Table 2.
Conclusion:
FCSA of affected side of paraspinal muscle is smaller than the other side in patients with hemiplegia. Fat infiltration is also increased in affected side of paraspinal in patients with hemiplegia. Asymmetric paraspinal muscles might be associated with trunk imbalance. Furthermore, the association of such morphological asymmetry and functional parameters such as postural stability and activities of daily living (ADL) should be further studied. |
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Table 1. Baseline characteristics of subjects
Table 2. Bilateral paraspinal muscle measurements at L4-L5 level
Figure. Measurement of total cross-sectional area of left multifidus muscle at L4–L5 (Left). Lean muscle functional cross-sectional area (FCSA) of the muscle using a threshold method is represented by the area not highlighted in green (Right).
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