Sonography Evaluation of Stabilization Muscles of Lumbar Spine in Vertebrogenic Patients

Czech version

Authors: M. Holinka ^1,2; J. Gallo ²; J. Zapletalová ³
Authors‘ workplace: Ortopedické oddělení, Karvinská hornická nemocnice, a. s. prim. MUDr. R. Pavličný ¹; Ortopedická klinika, Fakultní nemocnice Olomouc, Univerzita Palackého v Olomouci prof. MUDr. J. Gallo, Ph. D. ²; Ústav lékařské biofyziky, Lékařská fakulta, Univerzita Palackého v Olomouci prof. RNDr. H. Kolářová, CSc. ³
Published in: Rehabil. fyz. Lék., 23, 2016, No. 2, pp. 64-73.
Category: Original Papers

Overview

Introduction:
Degenerative changes of lumbar spine with accompanying backache belong to the most frequent complaints encountered in clinical practice. A wide spectrum of potential causes is associated with extensive changes in muscular stabilizers of the spine. The objective of this work was to evaluate the thickness of selected stabilization muscles by means of sonography examination in patients with chronic impairment of lumbar spine and to compare the results with a control group of healthy individuals.

Methodical procedure:
The study included 63 patients on the whole, 22 of them being men (34.9%) and 41 women (65.1%) at the age of 21 to 83 years. Forty eight patients (76.2%) with chronic backache formed the group of patients and 15 patients (23.8%) represented young and healthy individuals within the framework of the control group. Each patient underwent clinical examination and assessed intensity of the presently perceived pain on the basis of a visual analogous scale (VAS). At the same time all patients filled out the OSWESTRY questionnaire, which is considered as a “gold standard” in determination of subjective measure of limitation in ordinary daily activities.

Results:
In patients with chronic pains in lumbar spine (VAS 1 – 100 mm), the mean thickness of musculus obliquus abdominis internus, transversus abdominis and multifidus were always less than in the control group of healthy individuals. In the case of musculus multifidus we always determined linearly decreasing dependence of the thickness of stabilization muscles in comparison with the increasing intensity of the backache. In the subgroups of patients divided according to a subjective measure of limitation in ordinary daily activities on the basis of the OSWESTRY questionnaire (OSWESTRY 1 – 20 %, 21 – 40 %, 41 – 100 %), we observed even in this case there were lower mean thicknesses in musculus obliquus abdominis internus, transversus abdominis and multifidus than in the control group of healthy individuals. In the case of musculus obliquus abdominis internus were observed a linearly decreasing dependence in the muscle thickness as compared with the increasing limitation according to the OSWESTRY questionnaire. The sonography examination also revealed high individual variability of the measured muscle in resting muscles as well as after a load in both groups investigated. This kind of variability was particularly noticeable in musculus multifidus in the group of patients with chronic backache, where the observed difference in the muscle thickness at rest and after the load proved to be 39mm and 47mm, respectively.

Conclusion:
In patients with different type and degree of chronic disease of lumbar spine the authors determined lower thickness of the selected stabilization muscles as compared with the healthy control group. Sonography examination also revealed high individual variability of the measured muscles. A higher intensity of backache and greater limitation in ordinary daily activities (VAS pain, OSWESTRY questionnaire) correlated in some cases with the decreasing thickness of the muscles measured.

Keywords:
sonography, stabilization muscles of lumbar spine, muscle thickness, visual analogous scale, OSWESTRY questionnaire

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Article was published in

Rehabilitation and Physical Medicine

2016 Issue 2