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Case Reports
. 2014 May 31;8(5):27-34.
doi: 10.3941/jrcr.v8i5.1401. eCollection 2014 May.

Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series

Mark Woodham  1 , Andrew Woodham  2 , Joseph G Skeate  3 , Michael Freeman  4
Affiliations
Case Reports

Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series

Mark Woodham et al. J Radiol Case Rep. .

Abstract

A retrospective case series of three patients with chronic low back pain who received baseline MRI scans revealing multifidus muscle atrophy with fatty replacement is provided. Each patient received spinal manipulative therapy, and two were compliant with low back exercises targeting the multifidus. A follow-up scan performed >1 year later was compared to the baseline scan revealing a decrease in atrophy with fatty replacement in the two patients who performed multifidus-focused low back exercises (15% and 39% on the left and 7% and 32% on the right respectively), and an increase in the patient who underwent spinal manipulation alone (41% and 53%). Interestingly, the decrease in atrophy in the two patients that performed the exercises correlated to functional improvements. Though limited, these results highlight the utility of MRI in quantifying positive and negative long-term changes in multifidus atrophy, which may be an indicator of recovery in chronic low back pain patients.

Keywords: Lumbar multifidus muscle; MRI; chronic low back pain; lumbar multifidus muscle atrophy; multifidi.

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Figures

Figure 1
Figure 1
Lumbar multifidus muscle (LMM) fatty atrophy is most commonly seen medially and deep in transverse MR images of the lumbar spine.
Figure 2
Figure 2
Patient 1: 30 year old male diagnosed with a lumbar sprain/strain, and disc herniations at levels L3-L4, L5-S1, and muscle spasming. FINDINGS: Baseline MRI transverse sequences revealed posterior disc protrusion at the L5-S1 level w/a focal herniation on the left contacting the S1 nerve root; midline disc protrusion at L3-L4 level; disc degeneration L3-S1 in addition to LMM atrophy (asymmetric multifidus muscle atrophy at L5-S1 avg. approx. 32.4% on the left and 23.4% on the right). The follow-up MRI transverse sequences were performed 44 months post baseline at a different facility revealing decreased LMM atrophy [asymmetric multifidus muscle atrophy at L5-S1 avg. approx. 27.5% on the left (15% decrease) and 21.8% on the right (7% decrease)] compared to baseline MRI. White arrows indicate areas of highest lumbar multifidus fatty atrophy decrease between baseline and follow up. TECHNIQUE: Baseline MRI: 1.5T scanner, transverse non-contrast T1-weighted sequences, TR: 627.0 and TE: 15.0. Follow-up MRI: 1.5T scanner, transverse non-contrast T1-weighted sequences, TR: 450.0 and TE: 10.0.
Figure 3
Figure 3
Patient 2: 41 year old male diagnosed with a lumbar sprain/strain, and right foot paresthesias. FINDINGS: Baseline MRI transverse sequences revealed mild posterior disc bulge at L4-L5 level; mild bilateral intervertebral stenosis at the L5-S1 level; intervertebral disc degeneration L4-S1 in addition to LMM atrophy (asymmetric multifidus muscle atrophy at L4-S1 avg. approx. 20.3% on the left and 13.0% on the right). The follow-up MRI transverse sequences were performed 72 months post baseline at a different facility revealing decreased LMM atrophy [asymmetric multifidus muscle atrophy at L4-S1 avg. approx. 12.3% on the left (39% decrease) and 8.8% on the right (32% decrease)] compared to baseline MRI. White arrows indicate areas of highest lumbar multifidus fatty atrophy decrease between baseline and follow up. TECHNIQUE: Baseline MRI: 1.5T scanner, transverse non-contrast T1-weighted sequences, TR: 650.0 and TE: 14.0. Follow-up MRI: 1.5T scanner, transverse non-contrast T1-weighted sequences, TR: 500.0 and TE: 13.1.
Figure 4
Figure 4
Patient 3: 29 year old male diagnosed with a lumbar sprain/strain, herniated discs: L4-L5, L5-S1, sciatic neuralgia, and muscle spasming. FINDINGS: Baseline MRI transverse sequences revealed L4-L5: right paracentral disc protrusion; L5- S1: mild degenerative disc disease, and subtle left paracentral protrusion in addition to LMM atrophy (asymmetric multifidus muscle atrophy at L4-S1 avg. approx. 12.2% on the left and 11.6% on the right). The follow-up MRI transverse sequences were performed 12 months post baseline at a different facility revealing increased LMM atrophy [asymmetric multifidus muscle atrophy at L4-S1 avg. approx. 17.2% on the left (41% increase) and 17.8% on the right (54% increase)] compared to baseline MRI. White arrows indicate areas of highest lumbar multifidus fatty atrophy increase between baseline and follow up. TECHNIQUE: Initial MRI: 1.0T scanner, transverse non-contrast T1-weighted sequences, TR: 621.0 and TE: 12.0. Follow-up MRI: 1.5T scanner, transverse non-contrast T1-weighted sequences, TR: 550.0 and TE: 13.1.
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