Fat infiltration of paraspinal muscles is associated with low back pain...

[101N]

Hmm, and RFA ?

Spine J. 2015 Jul 1;15(7):1593-601. doi: 10.1016/j.spinee.2015.03.039. Epub 2015 Mar 28.
Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults.
Teichtahl AJ1, Urquhart DM2, Wang Y2, Wluka AE2, Wijethilake P2, O'Sullivan R3, Cicuttini FM2.
Author information

Abstract
BACKGROUND CONTEXT:
Low back pain and disability are major public health problems and may be related to paraspinal muscle abnormalities, such as a reduction in muscle size and muscle fat content.

PURPOSE:
The aim of this study was to examine the associations between paraspinal muscle size and fat content with lumbar spine symptoms and structure.

STUDY DESIGN/SETTING:
This was a community-based magnetic resonance imaging (MRI) cohort study.

PATIENT SAMPLE:
A total of 72 adults not selected on the basis of low back pain were included in the study.

OUTCOME MEASURES:
The outcomes measured were lumbar modic change and intervertebral disc height. Pain intensity and disability were measured from the Chronic Pain Grade Questionnaire at the time of MRI.

METHODS:
The cross-sectional area (CSA) and amount of fat in multifidus and erector spinae (high percentage defined by >50% of muscle) were measured, and their association with outcome was assessed.

RESULTS:
Muscle CSA was not associated with low back pain/disability or structure. High percentage of fat in multifidus was associated with an increased risk of high-intensity pain/disability (odds ratio [OR], 12.6; 95% confidence interval [CI], 2.0-78.3; p=.007) and modic change (OR, 4.3; 95% CI, 1.1-17.3; p=.04). High fat replacement of erector spinae was associated with reduced intervertebral disc height (β=-0.9 mm; 95% CI, -1.4 to -0.3; p=.002) and modic change (OR, 4.9; 95% CI, 1.1-21.9; p=.04).

CONCLUSIONS:
Paraspinal fat infiltration, but not muscle CSA, was associated with high-intensity pain/disability and structural abnormalities in the lumbar spine. Although cause and effect cannot be determined from this cross-sectional study, longitudinal data will help to determine whether disabling low back pain and structural abnormalities of the spine are a cause or result of fat replacement of paraspinal muscles.

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[cbest]

So was fat replacement only in multifidus or all erector spinae musculature? Seems like all musculature affected which is consistent with deconditioning.

 

[lobelsteve]

I poke fun at the biscuit poisoning behind the muscle and the marblinf in the muscle when reviewing the MRI with the patient. They can see the problem and know they need the exercises to get better.

 

[Ducttape]

this makes me wonder... how does affecting the multifidus through RFA alter mechanics? are we modulating pain when denervating the multifidus?

could RFA make a patient worse??

 

[bedrock]

of course 101N likes that post because he thinks no procedures work, because all he sees in his clinic are the most crazy, f----ed up people in Oregon, for whom no procedure works because procedures don't fix crazy, (but they do help normal people)

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Regarding RFA making someone worse. Think about who is your typical RFA person---over 55yrs old and their facet joints are shot to hell......or the MBB/RFA wouldn't work. If their joints are at least 75% destroyed/painful, working on their core muscles won't do a damn thing any more than leg exercises will help end-stage severe hip/knee oa, they just need the RFA for their facet joints.

On the other hand, the remote possibility of multifidi denervation worsening stability might cause one to consider a trial of intra-articular facet joint injections in a young patient after MVA.

I do IA facet injections as an initial procedure regularly for young patients (under 55). I don't do it because of multifidi considerations, but because early facet degeneration tends to respond longer to IA facet injections, compared to severe facet degeneration and it's less to put the patient through. Many truly young MVA patients (<35yrs) just need one IA facet injection and they never need me again, and many younger patients freak out at the idea of RF, but those patients who require repeat IA injections and need them every 3-4 months, come around to the idea of RF by the time they need their third IA injection.

 

[ampaphb]

http://www.ncbi.nlm.nih.gov/pubmed/19695523

 

[SSdoc33]

http://www.ncbi.nlm.nih.gov/pubmed/19695523

im a bit skeptical of anything bogduk writes that might harm his beloved baby (radiofrequency). for this reason, i do tend to save the RFs for the "older" patients like bedrock.

 

[clubdeac]

http://www.ncbi.nlm.nih.gov/pubmed/19695523

Not sure how a study with 5 patients got published.

 

[SSdoc33]

Not sure how a study with 5 patients got published.

#1: bogduk. he could puke on a piece of paper and someone would publish it.
#2: PM&R journal isnt exactly NEJM

 

[ampaphb]

Not sure how a study with 5 patients got published.

You are absolutely right. Given the absolute crap NEJM has published re pain, PMR is a much more reputable publication.

 

[lobelsteve]

You are absolutely right. Given the absolute crap NEJM has published re pain, PMR is a much more reputable publication.

ALthough the one that just showed up had a point/counterpoint on cooled RF vs regular RF. Disclosures reveal the editor is paid by Kimberly Clark. Ugh