ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 18 of 47
УЖМБС 2019, 4(1): 129–140
Clinical Medicine

Ultrasonography of Paravertebral Muscles of Patients with Lumbar Spine Degenerative Diseases and Prognosis of their Surgical Treatment Results

Radchenko V. O. 1, Skidanov A. G. 1, Vishnyakov A. E. 1, Yakovenko S. M. 1, Kotulsky I. V. 1, Nessonova M. M. 2

The article deals with the issues of the establishment of ultrasonography criteria for assessing the status of paravertebral muscles of patients with degenerative diseases of the lumbar spine and predicting the results of their surgical treatment. Material and methods. We studied the results of a survey of 74 patients (31 men and 43 women) who were operated in the clinic of vertebrology for degenerative diseases of the lumbar spine. All patients were divided into four groups – N, G, S, and St. Group N consisted of 15 (20.27%) persons with unstable vertebral segments, a group of G had 25 patients (33.78 %) with diagnosis of an intervertebral disc hernia during the examination. Group S was represented by 15 (20.27 %) patients with spondylolisthesis, St group had 19 (25.68 %) patients with spinal stenosis. Fifth group was control and had 12 people in it. An ultrasonography study was conducted in real-time on the Toshiba Aplio, Japan. Linear ultrasound sensors with a frequency of 5.0-7.5 MHz were used to assess the state of skeletal muscle. Results and discussion. Among the patients selected for surgical treatment, 13 (17.6%) had severe disabilities, 30 (40.5%) were disabled, and 31 (41.9%) had ligament disturbances. After surgical treatment, minimal disabilities were observed in 24 patients (32.4%), moderate in 37 (50.0%), and 13 (17.6%) remained serious and invalidating disorders. Most results of the operations performed at the Institute of Vertebrology Clinic were evaluated as the best and most satisfactory. Therefore, for the selection of the necessary group with unsatisfactory results, it was necessary to search for a longer time. This group is of particular interest. It included 13 people (5 men and 8 women) aged 53.54 ± 2.54. That is, unsatisfactory results of surgical treatment are defined in patients older than 48 years. The diagnosis of "stenosis of the lumbar spine canal" was determined in 8 (61.54%) of them, hernia of the intervertebral disc was in 3 (23.08%) patients, spondylolisthesis was diagnosed in 2 (15.38%) of them. Patients of this group were performed surgical treatment that improved their condition: the significance of Osvetic disabilitative index changes (Wilcoxon Z = 3.179797, p <0.05) was found, but their condition remained difficult after surgery. In two patients, the degree of disability abilities after treatment has not changed. Prior to surgical treatment, serious violations (degree of severity III) were detected in 1 patient from this group. Disorders resulting in disability (gravity IV) were found in 4 patients; disorders of bedding (V degree) were noted in 8 patients. After treatment the disability in 9 patients was qualified as serious (degree of severity III), and 4 of them had the IV degree of severity. Conclusion. Thus, with the help of ultrasonography we observed stenosis in most degenerative diseases of the lumbar spine that increased echogenicity and violation of the structure of paravertebral muscles. The "Instability" group does not differ from the control one in any indicators. The hernias occupy an intermediate position (they are closer to stenosis and spondylolisthesis in thickness of muscle layer, and on indicators that take into account PZH, sometimes do not differ from control or from instability). We also proved the dependence between ultrasonography changes of paravertebral muscles and the results of surgical treatment of patients with degenerative lesions of the lumbar spine. The main factors of influence are the thickness of the muscular layer, increased echogenicity of the tissue and the significance of the ratio of the subcutaneous fat layer / muscle layer. We proposed the model which allows predicting the results of surgical treatment based on ultrasonography data of paravertebral muscles in patients with degenerative diseases of the lumbar spine with an accuracy of 84.4%.

Keywords: degenerative diseases of the spine, lumbar spine, paravertebral muscles, ultrasonography, prediction of the results of surgical treatment

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  1. Jacobson JA. Fundamentals of musculoskeletal ultrasound. Philadelphia: Saunders Elsevier; 2007. 346 p.
  2. Ozcakar A, Ток F, De Muynck M, Vanderstraeten G. Musculoskeletal sonography in physical and rehabilitation medicine. J Rehabil Med. 2012; 44(4): 310–8.
  3. Mironov SP, Eskin NA, Orletskiy AK, i dr. Ultrazvukovaya diagnostika patologii poperechno-polosatykh myshts. Vestnik travmatologii i ortopedii im NN Priorova. 2005; 1: 24–33. [Russian]
  4. Mironov SP, Burmakova GM, Saltykova VG, i dr. Diagnosticheskie vozmozhnosti sonografii pri poyasnichno-kresttsovykh bolyakh. Vestnik travmatologii i ortopedii im NN Priorova. 2003; 1: 24–31. [Russian]
  5. Zubarev AR, Nemenova NA. Ultrazvukovoe issledovanie oporno-dvigatelnogo apparata u vzroslykh i detey. M: Izdatelskiy dom «Vidar»; 2006. 136 p. [Russian]
  6. MakNelli Yu. Ultrazvukovoe issledovanie kostno-myshechnoy sistemy: Prakticheskoe rukovodstvo. Eds by GI Nazarenko, IB Geroeva; per s angl AN Khitrova. M: Izdatelskiy dom «Vidar»; 2007. 400 с. [Russian]
  7. Bucklein W, Vollert K, Wohlgemuth A, Bohndorf K. Ultrasonography of acute musculoskeletal disease. Eur Radiol. 2000; 10(2): 290–6.
  8. Heidari P, Farahbakhsh F, Rostami M, Noormohammadpour P, Kordi R. The role of ultrasound of the causes of low back pain: a review of the literature. Asian J Sports Med. 2015; 6(1): e23803.
  9. Arts IM, Pillen S, Schelhaas HJ, Overeem S, Zwarts MJ. Normal values for quantitative muscle ultrasonography in adults. Muscle Nerve. 2010; 41(1): 32–41.
  10. Pillen S, Verrips A, Van Alfen N, Arts IM, Sie LT, Zwarts MJ. Quantitative skeletal muscle ultrasound: diagnostic value in childhood neuromuscular disease. Neuromuscul Disord. 2007; 17(7): 509–16.
  11. Radchenko VA, Skidanov AG, Zmienko YuA, i dr. Otsenka sostoyaniya paravertebralnykh myshts poyasnichnogo otdela pozvonochnika s pomoshchyu kompyuternoy tomografii (obzor literatury). Ortopediya, travmatologiya i protezirovanie. 2013; 4: 128–33. [Russian]
  12. Ondo WG, Haykal HA. Paraspinal muscle asymmetry in Parkinson’s disease. Int J Neurosci. 2013; 124(2): 93–6.
  13. Skidanov AH, Avrunin OH, Tymkovich MYu, ta in. Otsinyuvannya paravertebralnykh m’yakykh tkanyn za dopomohoyu komp’yuternoi tomohrafiyi. Ortopediya, travmatologiya i protezirovanie. 2015; 3: 61–5. [Ukrainian]
  14. Patent 111269 Ukraine, MPK A61B 6/03, G06T 7/40, G06F 15/18. Sposib vyznachennya struktury paravertebralnykh m’yaziv za dopomohoyu komp’yuternoi tomohrafiyi / Avrunin OH, Skidanov AH, Radchenko VO, ta in. (UA); zayavnik i vlasnik patentu DU «IPKhS im prof MI Sytenka NAMN» (UA). № а201410285; zayavl 19.09.2014; opubl 10.02.2015, Byul № 3. [Ukrainian]
  15. Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomislic V, et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine. 2017; 42(8): 616–23.
  16. Xu WB, Liu JH, Chen ZJ, Fang XQ, Fan SW, Hu ZJ. Multifidus muscle atrophy not observed following two-segment anterior interbody fusion: a rabbit model study with a 12-month follow-up. Spine. 2017; 42(10): 711–7.
  17. Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H, Yamano Y. New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine. 2016; 41(2): E84–E90.
  18. Ohe A, Kimura T, Goh AC, Oba A, Takahashi J, Mogami Y. Characteristics of trunk control during crook-lying unilateral leg raising in different types of chronic low back pain patients. Spine. 2015; 40(8): 550–9.
  19. Nagar VR, Hooper TL, Dedrick GS, Brismée JM, Sizer PS Jr. Effect of recurrent low back pain history on volitional preemptive abdominal activation during a loaded functional reach activity. Spine. 2014; 39(2): E89–E96.
  20. Kim BJ, Lee SK. Effects of three spinal stabilization techniques on activation and thickness of abdominal muscle. J Exerc Rehabil. 2017; 13(2): 206–9.
  21. Gibbon KC, Debuse D, Hibbs A, Caplan N. Reliability and precision of sonography of the lumbar multifidus and transversus abdominis during dynamic activities. J Ultrasound Med. 2017; 36(3): 571–81.
  22. Vohra P, Kasana VP, Arya RK. Role of MRI and ultrasonography in evaluation of multifidus muscle in chronic low back pain patients. Int J Res Med Sci. 2016; 4(12): 5302–9.
  23. Pillen S. Skeletal muscle ultrasound. Eur J Translational myology. 2010; 1(4): 145–55.
  24. Nielsen PK, Jensen BR, Darvann T, Jørgensen K, Bakke M. Quantitative ultrasound tissue characterization in shoulder and thigh muscles — a new approach. BMC Musculoskeletal Disorders. 2006; 7: 2.
  25. Zaidman CM, Malkus EC, Siener C, Florence J, Pestronk A, Al-Lozi M. Qualitative and quantitative skeletal muscle ultrasound in late-onset acid maltase deficiency. Muscle Nerve. 2011; 44(3): 418–23.
  26. Strafun SS. Kompleksne ortopedychne likuvannya khvorykh z zastarilymy ushkodzhennyamy plechovoho spletennya ta peryferiynykh nerviv verkhnoi kintsivky: Abstr. Dr. Sci. (Med.). Kyiv; 1999. 32 p. [Ukrainian]
  27. D'hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012; 17 (6): 584–8.
  28. Lee HI, Song J, Lee HS, Kang JY, Kim M, Ryu JS. Association between crosssectional areas of lumbar muscles on magnetic resonance imaging and chronicity of low back pain. Ann Rehabil Med. 2011; 35(6): 852–9.
  29. 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 (Phila Pa 1976). 2004; 29(22): E515–9.
  30. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA. Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain. J Gerontol A Biol Sci Med Sci. 2005; 60(11): 1420–4.
  31. Korzh NA, Prodan AI, Barysh AE. Patogeneticheskaya klassifikatsiya degenerativnykh zabolevaniy pozvonochnika. Ortopediya, travmatologiya i protezirovanie. 2004; 3: 5-13. [Russian]
  32. Fairbank JCI, Pyncet PB. The Oswestry disability index. Spine. 2000; 25(22): 2940-53.