Hofste A1, Soer R1,2, Hermens H3, Wagner H4, Oosterveld F2, Wolff A5, Groen G5
1University Medical Center Groningen, Spine Center, Groningen, Netherlands, 2Saxion University of Applied Sciences, Health, Enschede, Netherlands, 3University of Twente, Biomedical Signals & Systems, Enschede, Netherlands, 4Westfälische Wilhelmsuniversität Münster, Department of Movement Science, Münster, Germany, 5University Medical Center Groningen, Pain Anesthesiology, Groningen, Netherlands
Background: There is still debate about the role of low back muscles in etiology and therapy of non-specific Low Back Pain (nLBP), particularly, with regards to the stabilizing contribution of the Lumbar Multifidus (LM). Because of the complex morphology of the LM and variability in research techniques, it is unclear how LM studies should be interpreted. Additionally, it is unclear how visualizations of LM from anatomy studies are represented in anatomy atlases.
Purpose: To systematically review the literature and anatomical atlases on LM morphology.
Methods: Relevant studies were searched in PubMed (Medline) and Science Direct. Anatomical atlases were retrieved from multiple university libraries and online. Included atlases and studies were assessed at five items: visuals present (y/n), quality of visuals (in-/sufficient), labeling of Multifidus (y/n), clear description of region of interest (y/n), description of plane has been described (y/n). This risk of bias assessment tool was developed to assess the quality of description of anatomy, since existing risk of bias tables have only been developed to assess the methodology of studies.
Results: In total 69 studies were included. In 52 studies, LM was described as a superficial muscle at the levels L4 - S1. However, others presented the LM as deep intrinsic muscle. LM morphology was mostly determined by MRI, ultrasound imaging or drawings. A low risk of bias was found in 32 studies, as they scored a total of five points at the risk of bias assessment. Furthermore 19 anatomical atlases were included. The main outcome of the anatomy atlases was that LM is shown as a deep intrinsic back muscle covered by the erector spinae and fasci thoracolumbalis. Anatomy atlases presented the Multifidus from cervical to sacrum level similarly. Most anatomical atlases, 11 out of 19, had a score ≤ 3, which means a low quality of visualization.
Conclusion(s): Anatomy studies reported different LM morphology compared to anatomical atlases. Even between studies, there appears to be inconsistent reporting in LM anatomy. Variation in research techniques that are used for measuring LM morphology could influence variation in describing and presenting LM morphology.
Implications: This knowledge contributes to a better understanding of the role of LM in LBP patients. Furthermore, this knowledge could lead to a better and consistence decision making in treatments for LBP patients by physiotherapists.
Keywords: lumbar multifidus, low back pain, anatomy
Funding acknowledgements: This project was funded by Raak SIA.
Purpose: To systematically review the literature and anatomical atlases on LM morphology.
Methods: Relevant studies were searched in PubMed (Medline) and Science Direct. Anatomical atlases were retrieved from multiple university libraries and online. Included atlases and studies were assessed at five items: visuals present (y/n), quality of visuals (in-/sufficient), labeling of Multifidus (y/n), clear description of region of interest (y/n), description of plane has been described (y/n). This risk of bias assessment tool was developed to assess the quality of description of anatomy, since existing risk of bias tables have only been developed to assess the methodology of studies.
Results: In total 69 studies were included. In 52 studies, LM was described as a superficial muscle at the levels L4 - S1. However, others presented the LM as deep intrinsic muscle. LM morphology was mostly determined by MRI, ultrasound imaging or drawings. A low risk of bias was found in 32 studies, as they scored a total of five points at the risk of bias assessment. Furthermore 19 anatomical atlases were included. The main outcome of the anatomy atlases was that LM is shown as a deep intrinsic back muscle covered by the erector spinae and fasci thoracolumbalis. Anatomy atlases presented the Multifidus from cervical to sacrum level similarly. Most anatomical atlases, 11 out of 19, had a score ≤ 3, which means a low quality of visualization.
Conclusion(s): Anatomy studies reported different LM morphology compared to anatomical atlases. Even between studies, there appears to be inconsistent reporting in LM anatomy. Variation in research techniques that are used for measuring LM morphology could influence variation in describing and presenting LM morphology.
Implications: This knowledge contributes to a better understanding of the role of LM in LBP patients. Furthermore, this knowledge could lead to a better and consistence decision making in treatments for LBP patients by physiotherapists.
Keywords: lumbar multifidus, low back pain, anatomy
Funding acknowledgements: This project was funded by Raak SIA.
Topic: Musculoskeletal: spine; Disability & rehabilitation; Pain & pain management
Ethics approval required: No
Institution: n/a
Ethics committee: n/a
Reason not required: The study was a literature review
All authors, affiliations and abstracts have been published as submitted.
