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Fatty Infiltration in Multifidus Muscles and its Association With Spinal MRI Findings

Masume Bayat, Elham Keshavarz, Hamidreza Haghighatkhah, Morteza Sanei Taheri




Background: The present cross sectional study was conducted to evaluate the relation between fatty infiltration (FI) in multifidus muscles and spinal MRI findings among patients who referred to Sina Athar and Kosar imaging centers of Shahid Beheshti University of Medical Sciences
Methods: Discovertebral and facet joint degenerative changes, intervertebral foraminal narrowing, disk herniation and central canal stenosis in all lumbar levels and FI in multifidus muscles at the level of L5 vertebra were assessed on magnetic resonance imaging (MRI) studies of 333 patients, and correlation of these MRI changes with FI was identified.
Results: Among 333 patients (174 female), whose data were analyzed, 316 patients mentioned a positive history of back pain. We observed a significant relation between female sex and higher age with degrees of multifidus FI in L5 level. No significant association was found between the existence of back pain and the rate of multifidus FI. There was a significant negative relation between the activity level and the amount of multifidus FI. Considering weekly exercise level and hours of computer use, this association was not observed. Evaluating the relation between end plate and facet joint degenerative process and also neuroforaminal stenosis with multifidus FI, a statistically significant relation was noted. This correlation was not observed for central canal stenosis.
Conclusion: We concluded that the degree of multifidus FI was remarkably higher in female gender, older ages and subjects with more sedentary lifestyle. Moreover, a significant correlation existed between abnormal MRI imaging findings (degenerative process, discopathies, foraminal stenosis) and multifidus FI.


Low back pain; Fatty infiltration; Multifidi muscles


Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2012;380(9859):2163-96.

Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? Jama. 2010;303(13):1295-302.

Balagué F, Ferrer M, Rajmil L, Acuña AP, Pellisé F, Cedraschi C. Assessing the association between low back pain, quality of life, and life events as reported by schoolchildren in a population-based study. European journal of pediatrics. 2012;171(3):507-14.

Rawls A, Fisher RE. Developmental and functional anatomy of the spine. The genetics and development of scoliosis: Springer; 2018. p. 1-29.

Than C, Seidl L, Brown JM. Lumbar erector spinae and sacral multifidus contractile properties in healthy females and males as determined by laser displacement mechanomyography. Biomedical Signal Processing and Control. 2019;47:1-6.

Creze M, Soubeyrand M, Gagey O. The paraspinal muscle-tendon system: Its paradoxical anatomy. PloS one. 2019;14(4):e0214812.

Kelly M, Jacobs D, Wooten ME, Edeer AO. Comparison of electromyographic activities of lumbar iliocostalis and lumbar multifidus muscles during stabilization exercises in prone, quadruped, and sitting positions. Journal of physical therapy science. 2016;28(10):2950-4.

Beneck GJ, Story JW, Donald S. Postural cueing to increase lumbar lordosis increases lumbar multifidus activation during trunk stabilization exercises: Electromyographic assessment using intramuscular electrodes. journal of orthopaedic & sports physical therapy. 2016;46(4):293-9.

Cifu DX. Braddom's physical medicine and rehabilitation: Elsevier Health Sciences; 2015.

Daggfeldt K, Huang Q-M, Thorstensson A. The visible human anatomy of the lumbar erector spinae. Spine. 2000;25(21):2719-25.

Mannion AF. Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. Journal of electromyography and kinesiology. 1999;9(6):363-77.

Hu Z-J, He J, Zhao F-D, Fang X-Q, Zhou L-N, Fan S-W. An assessment of the intra-and inter-reliability of the lumbar paraspinal muscle parameters using CT scan and magnetic resonance imaging. Spine. 2011;36(13):E868-E74.

Mannion A, Käser L, Weber E, Rhyner A, Dvorak J, Müntener M. Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. European Spine Journal. 2000;9(4):273-81.

Mhuiris ÁN, Volken T, Elliott JM, Hoggarth M, Samartzis D, Crawford RJ. Reliability of quantifying the spatial distribution of fatty infiltration in lumbar paravertebral muscles using a new segmentation method for T1-weighted MRI. BMC musculoskeletal disorders. 2016;17(1):234.

Upadhyay B, editor CT and MRI evaluation of paraspinal muscle degeneration2015: European Congress of Radiology 2015.

Chen Y-Y, Pao J-L, Liaw C-K, Hsu W-L, Yang R-S. Image changes of paraspinal muscles and clinical correlations in patients with unilateral lumbar spinal stenosis. European Spine Journal. 2014;23(5):999-1006.

Fortin M, Videman T, GIBBONS L, BATTIÉ M. Paraspinal muscle morphology and composition. Medicine & Science in Sports & Exercise. 2014;46(5):893-901.

Fortin M, Gibbons L, Videman T, Battie M. Do variations in paraspinal muscle morphology and composition predict low back pain in men? Scandinavian journal of medicine & science in sports. 2015;25(6):880-7.

Wu W, Hu Z, Fan S, Xu W, Fang X, Zhao F. Influencing of chronic low back pain on multifidus muscle atrophy. Zhongguo gu shang= China journal of orthopaedics and traumatology. 2014;27(3):207-12.

Fortin M, Lazáry À, Varga PP, McCall I, Battié MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. European Spine Journal. 2016;25(5):1452-9.

Danneels L, Vanderstraeten G, Cambier D, Witvrouw E, Bourgois J, Dankaerts W, et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. British journal of sports medicine. 2001;35(3):186-91.

Foster D, Avillar M, Pollock M, Graves J, Dudley G, Woodard D, et al. 260 Adaptations In Strength And Cross-sectional Area Of The Lumbar Extensor Muscles Following Resistance Training. Medicine & Science in Sports & Exercise. 1993;25(5):S47.

Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine. 1996;21(23):2763-9.

Ikezoe T, Mori N, Nakamura M, Ichihashi N. Effects of age and inactivity due to prolonged bed rest on atrophy of trunk muscles. European journal of applied physiology. 2012;112(1):43-8.

Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg D, et al. Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Spine. 2007;32(15):1687-92.

Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC medicine. 2007;5(1):2.

.27 Keshavarz E, Dehghani Z, Mohammadi K, Haghighatkhah HR, Shobeirian F. Comparison of Pathologic Findings of Lumbosacral MRI between Low Back Pain Patients and the Controls. Journal of Research in Medical and Dental Science 2018;6(5): 213-216.


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