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Paraspinal muscle morphology, composition and asymmetries: determinants and relation to low back pain and pathology. Open Access


Other title
low back pain
muscle composition
muscle morphology
magnetic resonance imaging
paraspinal muscle
fatty infiltration
erector spinae
Type of item
Degree grantor
University of Alberta
Author or creator
Fortin, Maryse
Supervisor and department
Michele Crite Battie, Department of Physical Therapy
Examining committee member and department
Arthur Prochazka/Department of Physiology
Yan Yuan/School of Public Health
Michele Crites Battie/Department of Physical Therapy
Eric Parent/Department of Physical Therapy
Paulo Ferreira/Faculty of Health Sciences/University of Sydney
Faculty of Rehabilitation Medicine
Rehabilitation Science
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background The lumbar paraspinal muscles are critical to provide spine stability, maintain proper posture and assist trunk movement. Although considerable attention has been focused on the association between variations in paraspinal muscle morphology and low back pain (LBP), their role in the development and progression of LBP remains unclear. Purpose The purpose of this doctoral work was to identify potential determinants of paraspinal muscle asymmetry, characterize the natural progression of age-related changes in paraspinal muscle over a 15-year period and examine their association with LBP problems, and determine whether paraspinal muscle size, composition and asymmetry are risk indicators for the development of LBP. Materials and Methods Subjects were selected from the pre-existing database of the Twin Spine Study. Data were collected through a structured interview, physical examination and magnetic resonance imaging (MRI). Measurement of the multifidus and erector spinae muscle cross-sectional area (CSA), functional CSA (FCSA) (e.g. fat-free mass) and degree of asymmetry in size and composition was obtained from T2-weighted axial images for 202 men at baseline and 99 men at 15-year follow-up. A novel and highly reliable thresholding technique, allowing for the separation of muscle and fat tissue, was developed to perform quantitative measurements of paraspinal muscle composition. Results and Conclusions Of the factors investigated, the few that were significantly associated with paraspinal muscle asymmetry in cross-sectional analyses included handedness, disc height narrowing, the amount of physical activity performed at work and leisure and familial aggregation. Yet, with the exception of handedness and familial aggregation, the associations were generally inconsistent across muscles and spinal levels and explained little of the variance in paraspinal muscle asymmetry. Over the 15-year follow-up period, the multifidus and erector spinae showed similar morphological changes including a decrease in size and an increase in fatty infiltration and asymmetry. However, no significant correlation was found between the long-term paraspinal muscle changes and LBP history. Moreover, multifidus and erector spinae muscle size, composition and degree of asymmetry do not appear to be major risk factors for the short-term (1-year) or long-term (15-year) development or prognosis of LBP, including sciatica.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Fortin M, Battié MC. Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther;92(6):853-864.Fortin M, Yuan Y, Battié MC. Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther 2013 Jun 27 [Epub ahead of print]

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