Is the size and composition of the paraspinal muscles associated with low back pain? A systematic review

Publication date: Available online 26 July 2017
Source:The Spine Journal
Author(s): Tom A Ranger, Flavia M Cicuttini, Tue Secher Jensen, Waruna L Peiris, Sultana Monira Hussain, Jessica Fairley, Donna M Urquhart
Background ContextAlthough previous studies have investigated the association between paraspinal muscle morphology and low back pain (LBP), the results are conflicting.PurposeThis systematic review examined the relationship between size and composition of the paraspinal muscles and LBP.Study design/ setting: Systematic reviewPatient sample: N/AOutcome measures: N/AMethodsA systematic search of electronic databases was conducted to identify studies investigating the association between the cross-sectional area and/or fatty infiltration of the paraspinal muscles (erector spinae, multifidus, psoas and quadratus lumborum) and LBP. Descriptive data regarding study design and methodology were tabulated and a risk of bias assessment was performed.ResultsOf the 119 studies identified, 25 met the inclusion criteria. Eight studies were reported as having low to moderate risk of bias. There was evidence for a negative association between cross-sectional area (CSA) of multifidus and LBP, but conflicting evidence for a relationship between erector spinae, psoas and quadratus lumborum CSA and LBP. Moreover, there was evidence to indicate multifidus CSA was predictive of LBP for up to 12 months in men, but insufficient evidence to indicate a relationship for longer time periods. While there was conflicting evidence for a relationship between multifidus fat infiltration and LBP, there was no or limited evidence for an association for the other paraspinal musculature.ConclusionsThis review found evidence that multifidus CSA was negatively associated with and predictive of LBP, up to 12 months but conflicting evidence for an association between erector spinae, psoas and quadratus lumborum CSA, and LBP. To further understand the role of the paraspinal musculature in LBP, there is a need for high quality cohort studies which extend over both the short and longer term.



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