Cervical Multifidus Muscle Atrophy in Patients with Unilateral Cervical Radiculopathy
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Objective To assess the atrophy of cervical multifidus muscles in patients with unilateral cervical disc herniation or radiculopathy quantitatively and to investigate whether asymmetric muscle atrophy has the relationship with the severity of cervical disc herniation or radiculopathy. Method Twenty-four patients who had cervical disc herniation in magnetic resonance imaging (MRI) were evaluated. The patients were divided into 2 groups; patients with unilateral cervical radiculopathy in electrodiagnosis (RAD) and patients without definite radiculopathy (HIVD). Twenty six controls without disc herniation were also evaluated. Cervical multifidus muscles from C4-5 to C7-T1 levels were detected in T1 axial MRI, and total cross-sectional area (CSA) of multifidus muscle (TMA) and pure muscle CSA (PMA) were measured. Results The ratios of TMA in involved side to TMA in uninvolved side (ITMA/UTMA) and PMA in involved side to PMA in uninvolved side (IPMA/UPMA) in HIVD and RAD groups was significantly lower than those in control group especially at C7-T1 level (p＜0.05). We divided the levels of cervical spine into three parts according to lesions found in MRI or electrodiagnosis; above lesion level, at lesion level and below lesion level. Abnormal cases of IPMA/UPMA were not different among levels in HIVD group, but RAD group showed that most of abnormal cases were below lesion (60%). Conclusion Asymmetric multifidus atrophy was seen in patients with cervical disc herniation and radiculopathy. The ratio of pure muscle CSA between involved and uninvolved sides might be a useful parameter to differentiate patients with unilateral cervical radiculopathy from patients without radiculopathy.
Abstract
Objective To assess the atrophy of cervical multifidus muscles in patients with unilateral cervical disc herniation or radiculopathy quantitatively and to investigate whether asymmetric muscle atrophy has the relationship with the severity of cervical disc herniation or radiculopathy. Method Twenty-four patients who had cervical disc herniation in magnetic resonance imaging (MRI) were evaluated. The patients were divided into 2 groups; patients with unilateral cervical radiculopathy in electrodiagnosis (RAD) and patients without definite radiculopathy (HIVD). Twenty six controls without disc herniation were also evaluated. Cervical multifidus muscles from C4-5 to C7-T1 levels were detected in T1 axial MRI, and total cross-sectional area (CSA) of multifidus muscle (TMA) and pure muscle CSA (PMA) were measured. Results The ratios of TMA in involved side to TMA in uninvolved side (ITMA/UTMA) and PMA in involved side to PMA in uninvolved side (IPMA/UPMA) in HIVD and RAD groups was significantly lower than those in control group especially at C7-T1 level (p＜0.05). We divided the levels of cervical spine into three parts according to lesions found in MRI or electrodiagnosis; above lesion level, at lesion level and below lesion level. Abnormal cases of IPMA/UPMA were not different among levels in HIVD group, but RAD group showed that most of abnormal cases were below lesion (60%). Conclusion Asymmetric multifidus atrophy was seen in patients with cervical disc herniation and radiculopathy. The ratio of pure muscle CSA between involved and uninvolved sides might be a useful parameter to differentiate patients with unilateral cervical radiculopathy from patients without radiculopathy.
참고문헌 (24)
- Cote P, "The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults", Spine, 23, pp.1689~1698 (1998)
- Ylinen J, "Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial", JAMA, 289, pp.2509~2516 (2003)
- Jordan A, "A comparison of physical characteristics between patients seeking treatment for neck pain and age-matched healthy people", J Manipulative Physiol Ther, 20, pp.468~475 (1997)
- Rao R, "Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation", J Bone Joint Surg Am, 84-A, pp.1872~1881 (2002)
- Panjabi MM, "Critical load of the human cervical spine: an in vitro experimental study", Clin Biomech, 13, pp.11~17 (1998)
- Hayashi N, "Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury", Radiology, 223, pp.397~402 (2002)
- Elliott J, "Fatty infiltration in the cervical extensor muscles in persistent whiplash-associated disorders: a magnetic resonance imaging analysis", Spine, 31, pp.E847~855 (2006)
- Elliott J, "MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD)", Man Ther, 13, pp.258~265 (2008)
- Fernandez-de-Las-Penas C, "Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache", Cephalalgia, 27, pp.355~362 (2007)
- Hyun JK, "Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy", Spine, 32, pp.E598~602 (2007)
- Bogduk N, "The human lumbar dorsal rami", J Anat, 134, pp.383~397 (1982)
- Kim BJ, "Electromyographic technique for lumbar multifidus examination: comparison of previous techniques used to localize the multifidus", Arch Phys Med Rehabil, 86, pp.1325~1329 (2005)
- Fernandez-de-las-Penas C, "Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls", J Orthop Sports Phys Ther, 38, pp.175~180 (2008)
- Rubinstein SM, "A best-evidence review of diagnostic procedures for neck and low-back pain", Best Pract Res Clin Rheumatol, 22, pp.471~482 (2008)
- Campbell WW, "Focal atrophy of the multifidus muscle in lumbosacral radiculopathy", Muscle Nerve, 21, pp.1350~1353 (1998)
- Yoshihara K, "Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation", Spine, 26, pp.622~626 (2001)
- Zhao WP, "Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides", Spine, 25, pp.2191~2199 (2000)
- Hides J, "Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects", Man Ther, 13, pp.43~49 (2008)
- Barker KL, "Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability", Spine, 29, pp.E515~519 (2004)
- Zhang J, "Surgical anatomy of the nerves and muscles in the posterior cervical spine: a guide for avoiding inadvertent nerve injuries during the posterior approach", Spine, 28, pp.1379~1384 (2003)
- Wu PB, "The lumbar multifidus muscle in polysegmentally innervated", Electromyogr Clin Neurophysiol, 40, pp.483~485 (2000)
- Fisher MA, "Electrophysiology of radiculopathies", Clin Neurophysiol, 113, pp.317~335 (2002)
- Gilad R, "Cervical paraspinal electromyography: normal values in 100 control subjects", J Clin Neurophysiol, 23, pp.573~576 (2006)
- Cooper RG, "St Clair Forbes W, Jayson MI. Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain", Br J Rheumatol, 31, pp.389~394 (1992)