TY - JOUR
T1 - The Politics of Chronic LBP
T2 - Can We Rely on a Proxy-Vote? Linking Multifidus Intra-Myo-Cellular Lipid (IMCL) Fatty Infiltration With Arthrogenic Muscle Inhibition (AMI)-induced Chronic Nonspecific Low Back Pain
AU - Gabel, Charles Philip
AU - Mokhtarinia, Hamid Reza
AU - Melloh, Markus
PY - 2021/1/15
Y1 - 2021/1/15
N2 - STUDY DESIGN: Retrospective review of the literature. OBJECTIVE: To update recent trends in the use of magnetic resonance spectroscopy (MRS) analysis for CLBP. SUMMARY OF BACKGROUND DATA: The lumbar multifidus (MF) muscle has drawn sustained interest for some time, particularly related to its structure, role in spinal stability, and its association and clinical significance with CLBP. Additionally, the presence of MF-arthrogenic muscle inhibition (AMI) and its relation to induced CLBP, through depleted lumbar stabilization, has gained increased recognition. In contrast, the differential diagnostic use of MRS analysis has suggested specific links between the presence of MF myo-cellular lipid (MCL) infiltration and CLBP patients. METHODS: Review of the literature related to CLBP with the keywords MCL, MRS analysis, and MF-AMI. RESULTS: No articles discussed CLBP using the three key concepts in a single context. The use of MRS analysis has the capacity to distinguish between Extra-MCL (EMCL) and intra-MCL (IMCL) infiltration within the lumbar MF. It is suggested that EMCLs are more likely to be associated with age-related change, while the IMCLs appear more likely to be associated with the presence of CLBP. The increased recognition of MF-AMI as a primary cause of CLBP, and the potential that AMI parallels the presence of IMCLs, facilitates possible use of MRS as a means to quantify the basis of lumbar MF-AMI CLBP, and that proportional IMCL changes in the MF could serve as a 'proxy' to indicate the effectiveness of interventions directed at MF activation. CONCLUSIONS: It may be possible for IMCLs to serve as a 'proxy' prognostic marker of lumbar MF-AMI in CLBP patients. Further, if this assertion were correct, then reductions in IMCLs could potentially quantify recovery and the efficacy of rehabilitation management strategies directed at lumbar MF activation.Level of Evidence: 5.
AB - STUDY DESIGN: Retrospective review of the literature. OBJECTIVE: To update recent trends in the use of magnetic resonance spectroscopy (MRS) analysis for CLBP. SUMMARY OF BACKGROUND DATA: The lumbar multifidus (MF) muscle has drawn sustained interest for some time, particularly related to its structure, role in spinal stability, and its association and clinical significance with CLBP. Additionally, the presence of MF-arthrogenic muscle inhibition (AMI) and its relation to induced CLBP, through depleted lumbar stabilization, has gained increased recognition. In contrast, the differential diagnostic use of MRS analysis has suggested specific links between the presence of MF myo-cellular lipid (MCL) infiltration and CLBP patients. METHODS: Review of the literature related to CLBP with the keywords MCL, MRS analysis, and MF-AMI. RESULTS: No articles discussed CLBP using the three key concepts in a single context. The use of MRS analysis has the capacity to distinguish between Extra-MCL (EMCL) and intra-MCL (IMCL) infiltration within the lumbar MF. It is suggested that EMCLs are more likely to be associated with age-related change, while the IMCLs appear more likely to be associated with the presence of CLBP. The increased recognition of MF-AMI as a primary cause of CLBP, and the potential that AMI parallels the presence of IMCLs, facilitates possible use of MRS as a means to quantify the basis of lumbar MF-AMI CLBP, and that proportional IMCL changes in the MF could serve as a 'proxy' to indicate the effectiveness of interventions directed at MF activation. CONCLUSIONS: It may be possible for IMCLs to serve as a 'proxy' prognostic marker of lumbar MF-AMI in CLBP patients. Further, if this assertion were correct, then reductions in IMCLs could potentially quantify recovery and the efficacy of rehabilitation management strategies directed at lumbar MF activation.Level of Evidence: 5.
UR - http://www.scopus.com/inward/record.url?scp=85098834932&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000003758
DO - 10.1097/BRS.0000000000003758
M3 - Article
C2 - 33079906
AN - SCOPUS:85098834932
VL - 46
SP - 129
EP - 130
JO - Spine
JF - Spine
SN - 0362-2436
IS - 2
ER -