Polysegmental innervation of the medial paraspinal lumbar muscles.

Clinic for Rheumatology, Spinal Disorders and Neuromuscular Diseases, Mediclin Seidel-Klinik, Hebelweg 4, 79435, Bad Bellingen, Germany.
European Spine Journal (Impact Factor: 2.47). 03/2008; 17(2):300-6. DOI: 10.1007/s00586-007-0529-1
Source: PubMed

ABSTRACT A retrospective analysis was performed in a nine month period of the electrophysiological data, imaging and clinical findings of patients with monoradicular disc herniation compressing either the L5 or the S1 nerve root. The primary purpose of the analysis was to determine the distribution of pathological spontaneous activity in the medial paraspinal muscles on electromyographic examination in monoradicular L5 and S1 nerve root compression syndromes. Anatomically, the medial paraspinal muscles receive their innervation from a single root while the iliocostalis muscles and the longissimus muscle are thought to be innervated by multiple nerve roots. In the analysis, in single nerve root lesion of the L5 or S1 nerve root, electromyography of the medial paraspinal muscles revealed pathological spontaneous activity one to three vertebrae cranial to the disc herniation with extension to the opposite side of the lesion. In conclusion, the medial paraspinal muscles might be thought to be innervated by one single nerve root on anatomical studies, electrophysiologically the extension of axonal lesion signs of one single lumbar nerve root is much broader. The widespread distribution of the L5 and S1 nerve root must be taken into consideration on electromyographic examination of the medial paraspinal muscles.

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND CONTEXT: Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions. PURPOSE: To investigate asymmetry in cross-sectional area (CSA) and fat infiltration in multifidus and other paraspinal muscles in patients with acute or subacute unilateral symptoms of radiculopathy and concordant posterolateral disc herniation. If multifidus asymmetry is indeed related to local pathology, this may serve as a marker for helping to target the search for less clearly identifiable pathology responsible for low back-related symptoms, which currently remains elusive in approximately 85% of those seeking care. STUDY DESIGN: Cross-sectional observational study. PATIENT SAMPLE: Subjects were patients referred to magnetic resonance imaging (MRI) with unilateral leg symptoms of less than 6 weeks onset suggestive of radiculopathy, with a consistent posterolateral lumbar disc herniation verified on imaging. METHODS: Using T2-weighted axial MRI, measurements were obtained for total muscle CSA and signal intensity, functional (fat-free) CSA, and the ratio of functional CSA to total CSA. RESULTS: Forty-three subjects met the inclusion criteria. The ratio of functional CSA to total muscle CSA was smaller on the side of the herniation than on the unaffected side, both below (mean 0.69 vs. 0.72, p=.007) and at the level of herniation (mean 0.78 vs. 0.80, p=.031). Multifidus signal intensity (fat infiltration) was greater on the side of the herniation at the level below the herniation (p=.014). Contrary to expectation, greater total multifidus CSA was found ipsilateral to the pathology at the level of herniation (p=.033). No asymmetries were found at the level above the herniation or in any other paraspinal muscles, with the exception of higher signal in the erector spinae at the level and side of herniation. CONCLUSIONS: Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.
    The spine journal: official journal of the North American Spine Society 10/2012; · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To identify and highlight the variable causes of camptocormia. Literature review. Camptocormia (bent spine syndrome) is an acquired postural disease characterised by forward flexion of the thoraco-lumbar spine. Camptocormia leads to lumbar kyphosis and increases during walking or standing and completely disappears in supine position. Camptocormia is multicausal due to central or peripheral nervous system disease, idiopathic or due to some rare conditions. Camptocormia is most frequently associated with Parkinson's disease. Other causes include dystonia, multisystem atrophy, Alzheimer's disease, myopathy, motor neuron disease, myasthenia or chronic inflammatory demyelinating polyneuropathy. Rare causes include adverse reactions of drugs, disc herniation, arthritis, spinal trauma, paraneoplastic disorder, or psychiatric disease (more rarely than previously thought). Camptocormia is diagnosed upon clinical investigations, imaging of the cerebrum or spine, electromyography or muscle biopsy. Treatment is limited on supportive conservative measures, to withdrawal of causative drugs, electroconvulsive therapy, surgical correction or deep brain stimulation and effective only in single patients. Camptocormia is organic in the vast majority of the cases due to neurological disease, or rarely drugs, trauma, orthopedic abnormalities or idiopathic.
    Disability and Rehabilitation 12/2010; 33(17-18):1702-3. · 1.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the cross-sectional area (CSA) of both paraspinal and psoas muscles in patients with unilateral back pain using MRI and to correlate it with outcome measures. 40 patients, all with informed consent, with a minimum of 3 months of unilateral back pain with or without sciatica and one-level disc disease on MRI of the lumbosacral spine were included. Patients were evaluated with self-report measures regarding pain (visual analogue score) and disability (Oswestry disability index). The CSA of multifidus, erector spinae, quadratus lumborum and psoas was measured at the disc level of pathology and the two adjacent disc levels, bilaterally. Comparison of CSAs of muscles between the affected vs symptomless side was carried out with Student's t-test and correlations were conducted with Spearman's test. The maximum relative muscle atrophy (% decrease in CSA on symptomatic side) independent of the level was 13.1% for multifidus, 21.8% for erector spinae, 24.8% for quadratus lumborum and 17.1% for psoas. There was significant difference (p<0.05) between sides (symptomatic and asymptomatic) in CSA of multifidus, erector spinae, quadratus lumborum and psoas. However, no statistically significant correlation was found between the duration of symptoms (average 15.5 months), patient's pain (average VAS 5.3) or disability (average ODI 25.2) and the relative muscle atrophy. In patients with long-standing unilateral back pain due to monosegmental degenerative disc disease, selective multifidus, erector spinae, quadratus lumborum and psoas atrophy develops on the symptomatic side. Radiologists and clinicians should evaluate spinal muscle atrophy of patients with persistent unilateral back pain.
    The British journal of radiology 11/2010; 84(1004):709-13. · 2.11 Impact Factor


1 Download
Available from