Ann Rehabil Med.  2013 Aug;37(4):498-504. 10.5535/arm.2013.37.4.498.

The Location of Multifidus Atrophy in Patients With a Single Level, Unilateral Lumbar Radiculopathy

• Kang JI
• Kim SY
• Kim JH
• Bang H
• Lee IS

• KMID: 2266605
• DOI: http://doi.org/10.5535/arm.2013.37.4.498

Abstract

OBJECTIVE
To identify the correlations between the location of multifidus atrophy and the level of lumbar radiculopathy.
METHODS
Thirty-seven patients who had unilateral L4 or L5 radiculopathy were divided into 2 groups; the L4 radiculopathy (L4 RAD) group and the L5 radiculopathy (L5 RAD) group. Bilateral lumbar multifidus muscles at the mid-spinous process level of L4 vertebra (L4 MSP), the mid-spinous process level of L5 vertebra (L5 MSP), and the mid-sacral crest level of S1 vertebra (S1 MSC) were detected in T1 axial magnetic resonance imaging. The total muscle cross-sectional area of multifidus muscles (TMCSA) and the pure muscle cross-sectional area of multifidus muscles (PMCSA) were measured by a computerized analysis program, and the ratio of PMCSA to TMCSA (PMCSA/TMCSA) was calculated.
RESULTS
There were no significant differences in TMCSA between the involved and the uninvolved sides in both groups. PMCSA was only significantly smaller at the S1 MSC on the involved side as compared with the uninvolved side in the L5 RAD group. The ratio of PMCSA to TMCSA was the lowest at the L5 MSP on the involved side in the L4 RAD group and at the S1 MSC on the involved side in the L5 RAD group.
CONCLUSION
Our findings suggest that the most severe atrophy of multifidus muscle may occur at the mid-spinous process or mid-sacral crest level of the vertebra which is one level below the segmental number of the involved nerve root in patients with a single-level, unilateral lumbar radiculopathy.

Keyword

Radiculopathy; Muscular atrophy; Electromyography; Magnetic resonance imaging

MeSH Terms

Atrophy
Electromyography
Humans
Magnetic Resonance Imaging
Muscles
Muscular Atrophy
Radiculopathy
Spine

Figure

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  Fig. 1 A flowchart of subjects. S1 MSC, mid-sacral crest level of S1 vertebra; RAD, radiculopathy.

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  Fig. 2 Cross-sectional area (CSA) of multifidus muscles in a patient with right L5 radiculopathy. (A) shows axial planes at the mid-spinous process level of L4 vertebra (L4 MSP), the mid-spinous process level of L5 vertebra (L5 MSP), and the mid-sacral crest level of S1 vertebra (S1 MSC). (B) indicates total muscle CSA of multifidus muscles (TMCSA) at the S1 MSC. (C) indicates pure muscle CSA of multifidus muscles (PMCSA) at the S1 MSC.

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  Fig. 3 A schematic illustration of the multifidus fascicles arising from the spinous process of L1 vertebra and innervated by L1 nerve root (L1 fascicles).

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  Fig. 4 A schematic illustration of the multifidus fascicles at the mid-spinous process level of L5 vertebra (L5 MSP). The fascicles innervated by L4 nerve root (L4 fascicles) appose the spinous process of L5 vertebra.

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