Investigation Of The Role Of Multifidus Muscles In The Development Of Recurrent Lumbar Disc Herniation
Research Article
DOI:
https://doi.org/10.5281/zenodo.15183996Keywords:
Lumbar Disc Herniation, Multifidus Muscle, Cross-Sectional Area (CSA) and Muscle-Lamina Distance (MLD), Exercise ProgramAbstract
Introductıon: In our study, we used magnetic resonance imaging (MRI) to assess whether the atrophy of the multifidus muscle, which plays a crucial role in lumbar spine stabilization, could be prevented following a back exercise program after lumbar disc herniation surgery.
Objective: This research investigated the effect of multifidus muscles that undergo atrophy after lumbar disc herniation surgeries on the development of recurrent disc herniation.
Method: A total of 59 patients who underwent recurrent lumbar disc herniation surgeries were retrospectively examined. Multifidus muscle Cross-Sectional Area (CSA) and Muscle-Lamina Distance (MLD) of the patients before primary lumbar disc surgery and before recurrent surgery were measured radiologically using lumbar magnetic resonance imaging (MRI) images. Within the scope of these measurements, the effect of the multifidus muscle development exercise program application after lumbar disc herniation surgeries on the development of recurrent discs was statistically evaluated.
Results: The MLD measurement of the multifidus muscle before primary lumbar disc herniation surgery was not statistically significant between the exercise and non-exercise groups, while the MLD measurement of the multifidus muscle on the pathological disc side before lumbar recurrent disc surgery (p= 0.017) was statistically significant between the exercise and non-exercise groups. In the measurements taken by the first observer before lumbar recurrent disc herniation surgery, the mean MLD measurement of the multifidus muscle in the exercise group was 5.34. In contrast, the mean MLD measurement of the multifidus muscle in the non-exercise group was 6.83, which was statistically significant (p= 0.017). In addition, the first observer's measurement of the upper pathological disc distance before lumbar recurrent disc herniation surgery was statistically significant (p= 0.024). According to the evaluation made by the second observer, the mean MLD measurement of the multifidus muscle before lumbar recurrent disc herniation surgery was 5.56 in the exercise group. At the same time, it was 6.81 in the non-exercise group (p= 0.038), same result as the first observer.
Conclusion: Our study shows that exercise shortens the MLD distance and that an appropriate lumbar exercise program can prevent multifidus muscle atrophy.
References
Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain. 2024;28(2):181-198. doi:10.1002/ejp.2190
Maharty DC, Hines SC, Brown RB. Chronic Low Back Pain in Adults: Evaluation and Management. Am Fam Physician. 2024;109(3):233-244.
Wallwork SB, Braithwaite FA, O'Keeffe M, et al. The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ. 2024;196(2):E29-E46. doi:10.1503/cmaj.230542
Mandell BF. Pursuing the diagnosis of low back pain. Cleve Clin J Med. 2024;91(6):334-335. doi:10.3949/ccjm.91b.06024
Choi G, Raiturker PP, Kim MJ, Chung DJ, Chae YS, Lee SH. The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery. 2005;57(4):764-772. doi:10.1093/neurosurgery/57.4.764
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. 2000;9(4):266-272. doi:10.1007/s005860000190
Farshad M, Gerber C, Farshad-Amacker NA, Dietrich TJ, Laufer-Molnar V, Min K. Asymmetry of the multifidus muscle in lumbar radicular nerve compression. Skeletal Radiol. 2014;43(1):49-53. doi:10.1007/s00256-013-1748-7
Zhao WP, Kawaguchi Y, Matsui H, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine (Phila Pa 1976). 2000;25(17):2191-2199. doi:10.1097/00007632-200009010-00009
Yoshihara K, Shirai Y, Nakayama Y, Uesaka S. Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976). 2001;26(6):622-626. doi:10.1097/00007632-200103150-00012
Chiu AP, Chia C, Arendt-Nielsen L, Curatolo M. Lumbar intervertebral disc degeneration in low back pain. Minerva Anestesiol. 2024;90(4):330-338. doi:10.23736/S0375-9393.24.17843-1
Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010;10(7):575-580. doi:10.1016/j.spinee.2010.02.021
Rihn JA, Kurd M, Hilibrand AS, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95(1):1-8. doi:10.2106/JBJS.K.01558
Fabris de Souza SA, Faintuch J, Valezi AC, et al. Postural changes in morbidly obese patients. Obes Surg. 2005;15(7):1013-1016. doi:10.1381/0960892054621224
Mroz TE, Lubelski D, Williams SK, et al. Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 2014;14(10):2334-2343. doi:10.1016/j.spinee.2014.01.037
Kim KT, Park SW, Kim YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2009;34(24):2674-2678. doi:10.1097/BRS.0b013e3181b4aaac
Barth M, Diepers M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1976). 2008;33(3):273-279. doi:10.1097/BRS.0b013e31816201a6
Chin KR, Tomlinson DT, Auerbach JD, Shatsky JB, Deirmengian CA. Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study. J Spinal Disord Tech. 2008;21(2):139-144. doi:10.1097/BSD.0b013e318093e5dc
Kim WH, Lee SH, Lee DY. Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc. 2011;50(3):201-204. doi:10.3340/jkns.2011.50.3.201
Colakoglu B, Alis D. Evaluation of lumbar multifidus muscle in patients with lumbar disc herniation: are complex quantitative MRI measurements needed?. J Int Med Res. 2019;47(8):3590-3600. doi:10.1177/0300060519853430
Keller A, Gunderson R, Reikerås O, Brox JI. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976). 2003;28(13):1455-1460. doi:10.1097/01.BRS.0000067094.55003.AD
Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976). 2006;31(25):2926-2933. doi:10.1097/01.brs.0000248453.51165.0b
Faur C, Patrascu JM, Haragus H, Anglitoiu B. Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain. BMC Musculoskelet Disord. 2019;20(1):414. doi:10.1186/s12891-019-2786-7
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Europeanatolia Health Sciences Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
