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1.  Effect of spinal manipulation on the development of history-dependent responsiveness of lumbar paraspinal muscle spindles in the cat 
We determined whether spinal manipulation could prevent and/or reverse the decrease and increase in paraspinal muscle spindle responsiveness caused respectively by lengthening and shortening histories of the lumbar muscles. Single unit spindle activity from multifidus and longissimus muscles was recorded in the L6 dorsal root in anesthetized cats. Muscle history was created and spinal manipulation delivered (thrust amplitude: 1.0mm, duration: 100ms) using a feedback-controlled motor attached to the L6 spinous process. Muscle spindle discharge to a fixed vertebral position (static test) and to vertebral movement (dynamic test) was evaluated following the lengthening and shortening histories. For the static test, changes in muscle spindle responsiveness were significantly less when spinal manipulation followed muscle history (p<0.01), but not when spinal manipulation preceded it (p>0.05). For the dynamic test, spinal manipulation did not significantly affect the history-induced change in muscle spindle responsiveness. Spinal manipulation may partially reverse the effects of muscle history on muscle spindle signaling of vertebral position.
PMCID: PMC4045034  PMID: 24932019
Muscle spindle; proprioception; spinal manipulation; lumbar spine; paraspinal muscle; thixotropy; muscle history; chiropractic; Fuseau musculaire; proprioception; manipulation vertébrale; colonne lombaire; muscle paravertébral; thixotropie; antécédent musculaire; chiropratique
2.  The decreased responsiveness of lumbar muscle spindles to a prior history of spinal muscle lengthening is graded with the magnitude of change in vertebral position 
In the lumbar spine, muscle spindle responsiveness is affected by the duration and direction of a lumbar vertebra’s positional history. The purpose of the present study was to determine the relationship between changes in the magnitude of a lumbar vertebra’s positional history and the responsiveness of lumbar muscle spindles to a subsequent vertebral position and subsequent vertebral movement. Neural activity from multifidus and longissimus muscle spindle afferents in deeply anesthetized cats was recorded while creating positional histories of the L6 vertebra. History was induced using a displacement-controlled feedback motor. It held the L6 vertebra for 4 seconds at an intermediate position (hold-intermediate at 0mm) and at 7 positions from 0.07 to 1.55mm more ventralward and dorsalward which lengthened (hold-long) and shortened (hold-short) the lumbar muscles. Following the conditioning hold positions, L6 was returned to the intermediate position. Muscle spindle discharge at this position and during a lengthening movement was compared between hold-intermediate and hold-short conditionings and between hold-intermediate and hold-short conditionings. We found that regardless of conditioning magnitude, the 7 shortening magnitudes similarly increased muscle spindle responsiveness to both vertebral position and movement. In contrast, the 7 lengthening magnitudes produced a graded decrease in responsiveness to both position and movement. The decrease to position became maximal following conditioning magnitudes of ~0.75 mm. The decrease to movement did not reach a maximum even with conditioning magnitudes of ~1.55 mm. The data suggest that the fidelity of proprioceptive information from muscle spindles in the low back is influenced by small changes in the previous length history of lumbar muscles.
PMCID: PMC3749777  PMID: 22721784
lumbar spine; muscle spindle; proprioception; thixotropy; multifidus; longissimus
3.  Using vertebral movement and intact paraspinal muscles to determine the distribution of intrafusal fiber innervation of muscle spindle afferents in the anesthetized cat 
Increasing our knowledge regarding intrafusal fiber distribution and physiology of paraspinal proprioceptors may provide key insights regarding proprioceptive deficits in trunk control associated with low back pain and lead to more effective clinical intervention. The use of vertebral movement as a means to reliably stretch paraspinal muscles would greatly facilitate physiological study of paraspinal muscle proprioceptors where muscle tendon isolation is either very difficult or impossible. The effects of succinylcholine (SCh) on 194 muscle spindle afferents from lumbar longissimus or multifidus muscles in response to computer-controlled, ramp and hold movements of the L6 vertebra were investigated in anesthetized cats. Paraspinal muscles were stretched by moving the L6 vertebra 1.5 to1.7mm in the dorsal-ventral direction. Initial frequency (IF), dynamic difference (DD), their changes (Δ) following SCh injection (100-400μg ·kg−1), and post-SCh dynamic difference (SChDD) were measured. Muscle spindle intrafusal fiber terminations were classified as primary or secondary fibers as well as bag1 (b1c), bag2 (b2c), b1b2c, or chain (c) fibers. Intrafusal fiber subpopulations were distinguished using logarithmic transformation of SChDD and ΔIF distributions as established by previous investigators. Increases in DD indicate strength of b1c influence while increases in IF indicate strength of b2c influence. Out of 194 afferents, 46.9% of afferents terminated on b2c fibers, 46.4% on b1b2c fibers, 1% on b1c fibers and 5.7% terminated on c fibers. Based on these intrafusal fiber subpopulation distributions, controlled vertebral movement can effectively substitute for direct tendon stretch and allow further investigation of paraspinal proprioceptors in this anatomically complex body region.
PMCID: PMC3578157  PMID: 23229776
Muscle Spindle; Neurophysiology; Paraspinal Muscles; Trunk; Lumbar Spine; Succinylcholine
4.  Lumbar position sense acuity during an electrical shock stressor 
Optimal motor control of the spine depends on proprioceptive input as a prerequisite for co-ordination and the stability of the spine. Muscle spindles are known to play an important role in proprioception. Animal experiments suggest that an increase in sympathetic outflow can depress muscle spindle sensitivity. As the muscle spindle may be influenced by sympathetic modulation, we hypothesized that a state of high sympathetic activity as during mental stress would affect the proprioceptive output from the muscle spindles in the back muscles leading to alterations in proprioception and position sense acuity. The aim was to investigate the effect of mental stress, in this study the response to an electrical shock stressor, on position sense acuity in the rotational axis of the lumbar spine.
Passive and active position sense acuity in the rotational plane of the lumbar spine was investigated in the presence and absence of an electrical shock stressor in 14 healthy participants. An electrical shock-threat stressor lasting for approximately 12 minutes was used as imposed stressor to build up a strong anticipatory arousal: The participants were told that they were going to receive 8 painful electrical shocks however the participants never received the shocks. To quantify the level of physiological arousal and the level of sympathetic outflow continuous beat-to-beat changes in heart rate (beats*min-1) and systolic, diastolic and mean arterial blood pressure (mmHg) were measured. To quantify position sense acuity absolute error (AE) expressed in degrees was measured. Two-way analysis of variance with repeated measurements (subjects as random factor and treatments as fixed factors) was used to compare the different treatments.
Significant increases were observed in systolic blood pressure, diastolic blood pressure, and heart rate during the stress sessions indicating elevated sympathetic activity (15, 14 and 10%, respectively). Despite pronounced changes in the sympathetic activity and subjective experiences of stress no changes were found in position sense acuity in the rotational plane of the lumbar spine in the presence of the electrical shock stressor compared to the control period.
The present findings indicate that position sense acuity in the rotational plane of the spine was unaffected by the electrical shock stressor.
PMCID: PMC1185546  PMID: 15992402
5.  Lumbar paraspinal and biceps brachii muscle function and movement perception in lumbar spinal stenosis 
European Spine Journal  2012;22(4):788-793.
Impaired muscle function and lumbar proprioception have been observed in lumbar spinal stenosis (LSS) but those have not been studied in LSS patients with age-matched controls. We assessed lumbar movement perception and paraspinal and biceps brachii (BB) muscle responses during sudden upper limb loading in age-matched healthy subjects and patients with LSS.
The study included 30 patients selected for an operation due to LSS and 30 age-matched controls without chronic back pain. The paraspinal and BB muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in a seated position. Pain, disability and depression scores were recorded.
Patients had poorer lumbar perception (mean difference 2.3 ± 0.6°, P < 0.001) and longer paraspinal muscle response latencies [mean difference 4.6 ± 0.6 ms (P = 0.033)] than age-matched healthy controls. Anticipation increased paraspinal and BB muscle activation prior to the load perturbation (P < 0.001) but less in LSS patients than in controls [9 vs. 30 %, P = 0.016 (paraspinals); 68 vs. 118 %, P = 0.047 (BB)].
The observed impairments in lumbar proprioception and activation of paraspinal and upper limb muscles indicate an extensive loss of both sensory and motor functions in LSS. The main new finding was decreased anticipatory muscle activation during expected upper limb loading reflecting involvement of central movement control mechanisms.
PMCID: PMC3631031  PMID: 23179975
Lumbar proprioception; Paraspinal reflexes; Feed-forward control; Low back pain; Lumbar spinal stenosis
6.  An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles 
European Spine Journal  2005;15(6):764-773.
The purpose of this study was to investigate the use of magnetic resonance (MR) imaging and image processing software to determine the functional cross-sectional area (FCSA) (the area of muscle isolated from fat) of the lumbar paraspinal muscles. The measurement of the morphology of the lumbar paraspinal muscles has become the focus of several recent investigations into the aetiology of low back pain. However, the reliability and validity of determining the FCSA of the lumbar paraspinal muscles using MR imaging are yet to be reported. T2 axial MR scans at the L1-S1 spinal levels of six subjects were obtained using identical MR systems and scanning parameters. Lean paraspinal muscle, vertebral body bone and intermuscular fat were manually segmented using image analysis software to assign a grey scale range to the MR signal intensity emitted by each tissue type. The resultant grey scale range for muscle was used to determine FCSA measurements for each of the paraspinal muscles, psoas, quadratus lumborum, erector spinae and lumbar multifidus on each scan slice. As various biological, instrument and measurement factors can affect MR signal intensity, a sensitivity analysis was conducted to determine the error associated in calculating FCSA for paraspinal muscle using a discrete grey scale range. Cross-sectional area and FCSA measurements were repeated three times and reliability indices for the FCSA measurements were obtained, showing excellent reliability, intra class correlation coefficient (mean=0.97, range 0.90–0.99) and %SEM (mean=2.6%, range 0.7–4.8%). In addition, the error associated with miscalculation of the grey scale range for the MR signal intensity of muscle was calculated and found to be low with an error of 20 grey scale units at the upper end of the muscle’s grey scale range resulting in a very small error in the measured muscle FCSA. The method presented in this paper has a variety of practical applications in areas such as evidence-based rehabilitation, biomechanical modelling and the determination of segmental inertial parameters.
PMCID: PMC3489434  PMID: 15895259
Lumbar spine; Magnetic resonance imaging; Cross sectional area; Low back pain; Muscle morphology
7.  Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue 
Journal of Athletic Training  2009;44(5):475-481.
Isolated lumbar paraspinal muscle fatigue causes lower extremity and postural control deficits.
To describe the change in body position during gait after fatiguing lumbar extension exercises in persons with recurrent episodes of low back pain compared with healthy controls.
Case-control study.
Motion analysis laboratory.
Patients or Other Participants:
Twenty-five recreationally active participants with a history of recurrent episodes of low back pain, matched by sex, height, and mass with 25 healthy controls.
We measured 3-dimensional lower extremity and trunk kinematics before and after fatiguing isometric lumbar paraspinal exercise.
Main Outcome Measure(s):
Measurements were taken while participants jogged on a custom-built treadmill surrounded by a 10-camera motion analysis system.
Group-by-time interactions were observed for lumbar lordosis and trunk angles (P < .05). A reduced lumbar spine extension angle was noted, reflecting a loss of lordosis and an increase in trunk flexion angle, indicating increased forward trunk lean, in healthy controls after fatiguing lumbar extension exercise. In contrast, persons with a history of recurrent low back pain exhibited a slight increase in spine extension, indicating a slightly more lordotic position of the lumbar spine, and a decrease in trunk flexion angles after fatiguing exercise. Regardless of group, participants experienced, on average, greater peak hip extension after lumbar paraspinal fatigue.
Small differences in response may represent a necessary adaptation used by persons with recurrent low back pain to preserve gait function by stabilizing the spine and preventing inappropriate trunk and lumbar spine positioning.
PMCID: PMC2742456  PMID: 19771285
gait analysis; spine
8.  Effect of changing lumbar stiffness by single facet joint dysfunction on the responsiveness of lumbar muscle spindles to vertebral movement 
Individuals experiencing low back pain often present clinically with intervertebral joint dysfunction. The purpose of this study was to determine whether relative changes in stiffness at a single spinal joint alters neural responsiveness of lumbar muscle spindles to either vertebral movement or position.
Muscle spindle discharge was recorded in response to 1mm L6 ramp and hold movements (0.5mm/s) in the same animal for lumbar laminectomy-only (n=23), laminectomy & L5/6 facet screw (n=19), laminectomy & L5/6 facetectomy (n=5) conditions. Mean instantaneous frequency (MIF) was calculated for the ramp-up, hold, ramp-down and post-ramp phases during each joint condition.
Mean MIFs were not significantly different between the laminectomy-only and the other two types of joint dysfunction for the ramp-up, hold, ramp-down, or post-ramp phases.
Stiffness changes caused by single facet joint dysfunction failed to alter spindle responses during slow 1mm ramp and hold movements of the L6 vertebra.
PMCID: PMC4025086  PMID: 24932020
stiffness; joint; muscle spindle; chiropractic; rigidité; articulation; fuseau musculaire; chiropratique
9.  Microdialysis of paraspinal muscle in healthy volunteers and patients underwent posterior lumbar fusion surgery 
European Spine Journal  2009;18(11):1604-1609.
Paraspinal muscle damage is inevitable during conventional posterior lumbar fusion surgery. Minimal invasive surgery is postulated to result in less muscle damage and better outcome. The aim of this study was to monitor metabolic changes of the paraspinal muscle and to evaluate paraspinal muscle damage during surgery using microdialysis (MD). The basic interstitial metabolisms of the paraspinal muscle and the deltoid muscle were monitored using the MD technique in eight patients, who underwent posterior lumbar fusion surgery (six male and two female, median age 57.7 years, range 37–74) and eight healthy individuals for different positions (five male and three female, age 24.1 ± 0.8 years). Concentrations of glucose, glycerol, and lactate pyruvate ratio (L/P) in both tissues were compared. In the healthy group, the glucose and glycerol concentrations and L/P were unchanged in the paraspinal muscle when the body position changed from prone to supine. The glucose concentration and L/P were stable in the paraspinal muscle during the surgery. Glycerol concentrations increased significantly to 243.0 ± 144.1 μM in the paraspinal muscle and 118.9 ± 79.8 μM in the deltoid muscle in the surgery group. Mean glycerol concentration difference (GCD) between the paraspinal muscle and the deltoid tissue was 124.1 μM (P = 0.003, with 95% confidence interval 83.4–164.9 μM). The key metabolism of paraspinal muscle can be monitored by MD during the conventional posterior lumbar fusion surgery. The glycerol concentration in the paraspinal muscle is markedly increased compared with the deltoid muscle during the surgery. It is proposed that GCD can be used to evaluate surgery related paraspinal muscle damage. Changing body position did not affect the paraspinal muscle metabolism in the healthy subjects.
PMCID: PMC2899392  PMID: 19418074
Glucose; Lactate pyruvate ratio; Glycerol; Paraspinal muscle; Microdialysis
10.  Effect of Posture during Trumpet and Marching Euphonium Performance on the Trunk and Lower Limb Musculoskeletal System 
Journal of Physical Therapy Science  2013;25(9):1115-1117.
[Purpose] The purpose of the present study was to investigate the effect of trumpet and marching euphonium performance posture on the trunk and lower limb musculoskeletal system. [Subjects] The subjects were 10 female university students. [Methods] Subjects maintained a resting position, a trumpet performance posture, and a marching euphonium performance posture. The angles and muscle activities of the trunk and lower limbs were then measured. [Results] The anterior tilt angle of the trunk decreased significantly in the trumpet and marching euphonium performance postures compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. The muscle activity of the cervical paraspinal muscles, upper fibers of the trapezius, and lumbar paraspinal muscles increased significantly in the marching euphonium performance posture compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. [Conclusion] The results suggest that the performance position for trumpet and the marching euphonium performance increases the load on the cervical and thoracic musculoskeletal system, which increases with greater instrument weight. However, the same instrument performance postures had no affect on the musculoskeletal system of the lower limbs.
PMCID: PMC3818765  PMID: 24259926
Posture; Trunk; Lower limb
11.  Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae? 
Korean Journal of Radiology  2014;15(2):258-266.
To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI.
Materials and Methods
Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described.
The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization.
The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.
PMCID: PMC3955794  PMID: 24644411
Spine; Lumbosacral vertebrae; Transitional vertebrae; MRI
12.  Lumbar magnetic resonance imaging hypolordosis in symptomatic patients: association with paraspinal muscle spasms☆ 
This study examined a set of patients who were symptomatic for low back pain and who had significant lumbar hypolordosis as assessed by visual evaluation of magnetic resonance images to investigate the frequency of comorbid paraspinal muscle spasms as determined via history or physical examination.
A retrospective chart review was performed on 50 patients who had significant hypolordosis on magnetic resonance imaging (MRI) (Cobb angle <20°) to determine whether they were positive for paraspinal muscle spasms by either history or physical examination.
Of the 50 patients with significant hypolordosis on MRI, 66% (33) had a history of paraspinal muscle spasms, 76% (38) had a positive physical examination for palpation of paraspinal muscle spasms, and 48% (24) were positive for both history and physical examination.
This retrospective study suggests that most symptomatic patients with significant hypolordosis on lumbar MRI have a positive history or physical examination for paraspinal muscle spasm. Thus, MRI finding of significant hypolordosis (Cobb angle <20°) could potentially be a valuable tool in addition to medical history and physical examination in aiding clinicians in diagnosing paraspinal muscle spasms in symptomatic patients and in helping them to formulate appropriate and effective treatments.
PMCID: PMC2732250  PMID: 19703664
Lordosis; Spinal curvatures; Spinal diseases; Magnetic resonance imaging; Spasm
13.  Analysis of Relationship between Paraspinal Muscle Fatty Degeneration and Cervical Spine Motion Using Kinetic Magnetic Resonance Imaging 
Global Spine Journal  2012;2(1):33-38.
The alignment and mobility of the cervical spine is influenced by factors related to the vertebral bodies, intervertebral discs, ligaments, facet joints, and muscles. Few reports have described the role played by the paraspinal muscles in cervical spine mobility. In this study, we investigate the relationship between fatty degeneration of the paraspinal muscles and cervical motion as assessed with kinetic magnetic resonance imaging (kMRI). One hundred eighty-eight symptomatic patients underwent cervical kMRI in neutral, flexion, and extension positions. We quantified cervical paraspinal muscle fatty infiltration and measured angular variation and translational motion at each cervical level, and the global Cobb angle. Cervical paraspinal muscle fatty degeneration demonstrated a pattern in which C3 and C7 had significantly more fatty infiltration than C4, C5, and C6. Additionally, when the normal group was compared with the fatty degeneration group with respect to angular variation, translational motion, and Cobb angle, no significant differences were found except in angular variation at the C3–C4 level. In conclusion, we found a significantly larger quantity of fatty degeneration in the paraspinal muscles at C3 and C7 than the middle cervical levels. Also, we demonstrate that fatty degeneration does not significantly affect cervical lordotic alignment or mobility characteristics.
PMCID: PMC3864418  PMID: 24353944
kinematic magnetic resonance imaging; cervical spine; cervical paraspinal muscle; cervical lordosis; fatty degeneration; fatty infiltration; multifidus muscle
14.  The risk of hematoma following extensive electromyography of the lumbar paraspinal muscles 
Muscle & nerve  2012;46(1):26-30.
The purpose of this study is to provide a controlled trial looking at the risk of paraspinal hematoma formation following extensive paraspinal muscle electromyography.
54 subjects ages 55-80 underwent MRI of the lumbar spine before or shortly after electromyography using the paraspinal mapping technique. A neuroradiologist, blinded to the temporal relationship between the EMG and MRI, reviewed the MRIs to look for hematomas in or around the paraspinal muscles.
Two MRIs demonstrated definite paraspinal hematomas, while 10 were found to have possible hematomas. All hematomas were < 15 mm, and none were close to any neural structures. There was no relationship between MRI evidence of hematoma and either the timing of the EMG or the use of aspirin or other non-steroidal anti-inflammatory drugs.
Paraspinal electromyography can be considered safe in the general population and those taking non-steroidal anti-inflammatory drugs.
PMCID: PMC3374880  PMID: 22644875
Electromyography; Paraspinal muscles; Hematoma; Paraspinal mapping; Complications
15.  Synergy of the human spine in neutral postures 
European Spine Journal  1998;7(6):471-479.
The neutral position of the spine is the posture most commonly sustained throughout daily activities. Previous investigations of the spine focused mainly on maximal exertions in various symmetric and asymmetric postures. This report proposes a new synergetic approach for analysis of the spine in neutral postures and evaluates its performance. The model consists of passive components, the osteoligamentous spine, and active components, the spinal muscles. The muscle architecture includes 60 muscles inserting onto both the rib cage and lumbar vertebral bodies. The passive spine is simulated by a finite element model, while kinematic constraints and optimization are used for resolution of a redundant muscle recruitment problem. Although the passive spine alone exhibits little resistance to a vertical load, its load-bearing capacity in neutral posture is significantly enhanced by the muscles, i.e., the passive spine and its muscles must be considered as a synergetic system. The proposed method is used to investigate the response of the spine when the T1 vertebra displaces 40 mm anteriorly and 20 mm posteriorly from its initial position. The sacrum is fixed at all times and the T1 displacements are achieved by the action of muscles. The results suggest that relatively small muscle activations are sufficient to stabilize the spine in neutral posture under the body weight. The results also indicate that muscles attaching onto the rib cage are important for control of the overall spinal posture and maintenance of equilibrium. The muscles inserting onto the lumbar vertebrae are found mainly to enhance the stability of the spine. The proposed method also predicts forces and moments carried by the passive system. Flexion moments ranging from 8000 Nmm to 15,000 Nmm, corresponding to decreases in lordosis of 6° and 7.5° respectively, are found to be carried by the passive spine at the thoracolumbar junction when the T1 vertebra is 40 mm anterior to its initial position.
PMCID: PMC3611302  PMID: 9883956
Key words Synergy; Passive spine; Muscles; Equilibrium; Stability
16.  A prospective, masked 18 month minimum follow-up on neurophysiologic changes in persons with spinal stenosis, low back pain, and no symptoms 
To describe neurophysiological changes over time in persons with and without spinal complaints, and to assess whether paraspinal denervation predicts change in stenosis on MRI and clinical course.
Prospective, controlled, masked trial.
University spine program.
Persons aged 55–80, screened for polyneuropathy and determined on clinical examination to have spinal stenosis, mechanical low back pain, or no spinal symptoms.
Subjects underwent comprehensive codified history and physical examination, ambulation testing, masked electrodiagnostic testing including paraspinal mapping, and MRI; repeated at >18 months. This publication presents detailed technical information and additional analyses not reported previously.
Main Outcome Measurements
Change in electrodiagnostic findings. Among persons with clinical stenosis, relationship of change in paraspinal mapping scores to MRI findings and clinical changes.
Of 149 initial subjects, 83 (79.3% of eligible subjects) repeated testing at 20 +/− 2 s.d.) months. No significant change in limb muscle spontaneous activity or motor unit pathology was noted in any group. In 23 persons with initial diagnosis of stenosis, paraspinal mapping EMG related to change in diagnosis over time (ANOVA F=3.77, p=0.037), but not to most initial MRI measurements or to change in spinal canal diameter.
Clinical spinal stenosis is neurophysiologically stable in most persons. Paraspinal EMG changes reflect large changes in clinical course, but neither neurophysiological nor clinical changes relate to change in spinal geometry over 20 months.
PMCID: PMC2735230  PMID: 19627886
Spinal Stenosis; Back pain; Electrodiagnosis; Erector spinae; Disk Degeneration; Radiculopathy; Magnetic Resonance Imaging
17.  Anatomical study of the paraspinal approach to the lumbar spine 
European Spine Journal  2004;14(4):366-371.
The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. Thirty cadavers were dissected in order to precisely describe the anatomy of the trans-muscular paraspinal approach. The level of the natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was noted and measurements were done between this level and the midline at the level of the spinous process of L4. A natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was present in all cases. There was a fibrous separation between the two muscular parts in 55 out of 60 cases. The mean distance between the level of the cleavage plane and the midline was 4 cm (2.4–5.5 cm). In all cases, small arteries and veins were present, precisely at the level of the cleavage plane. We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.
PMCID: PMC3489211  PMID: 15526219
Paraspinal approach; Lumbar spine; Lumbosacral spondylolisthesis; Sacrospinalis muscle; Minimally invasive approach
18.  Relationships between joint motion and facet joint capsule strain during cat and human lumbar spinal motions 
The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and is thought to contribute to proprioception and pain. Biomechanical investigations of the FJC have commonly used human cadaveric spines, while combined biomechanical and neurophysiological studies have typically used non-human animal models. The purpose of this study was develop mathematical relationships describing vertebral kinematics and facet joint capsule strain in cat and human lumbar spine specimens during physiological spinal motions in order to facilitate future efforts at understanding the mechanosensory role of the FJC.
Cat lumbar spine specimens were tested during extension, flexion and lateral bending. Joint kinematics and FJC principal strain were measured optically. FJC strain-intervertebral angle (IVA) regression relationships were established for the three most caudal lumbar joints using cat (current study) and human (prior study) data. FJC strain-IVA relationships were utilized to estimate cat and human spine kinematics that corresponded to published sensory neuron response thresholds for low threshold mechanoreceptors (5% and 10%).
Significant linear relationships between IVA and strain were observed for both human and cat during motions that produced tension in the FJCs (p<0.01). During motions that produced tension in the FJCs, the models predicted that FJC strain magnitudes corresponding to published sensory neuron response thresholds would be produced by IVA magnitudes within the physiological range of lumbar motion.
Data from the current study support the proprioceptive role of lumbar spine FJC and low threshold mechanoreceptive afferents, and can be utilized in interpreting combined neurophysiological and biomechanical studies of cat lumbar spines.
PMCID: PMC3164964  PMID: 21875516
19.  Spinal lordosis optimizes the requirements for a stable erect posture 
Lordosis is the bending of the lumbar spine that gives the vertebral column of humans its characteristic ventrally convex curvature. Infants develop lordosis around the time when they acquire bipedal locomotion. Even macaques develop a lordosis when they are trained to walk bipedally. The aim of this study was to investigate why humans and some animals develop a lumbar lordosis while learning to walk bipedally.
We developed a musculoskeletal model of the lumbar spine, that includes an asymmetric, dorsally shifted location of the spinal column in the body, realistic moment arms, and physiological cross-sectional areas (PCSA) of the muscles as well as realistic force-length and force-velocity relationships. The model was used to analyze the stability of an upright body posture. According to our results, lordosis reduces the local joint torques necessary for an equilibrium of the vertebral column during an erect posture. At the same time lordosis increases the demands on the global muscles to provide stability.
We conclude that the development of a spinal lordosis is a compromise between the stability requirements of an erect posture and the necessity of torque equilibria at each spinal segment.
PMCID: PMC3349546  PMID: 22507595
muscle physiology; lordosis; evolution; spine; stability; biomechanics; motor control Submitted to: Theoretical Biology and Medical Modelling
20.  Effects of Static Flexion-relaxation on Paraspinal Reflex Behavior 
Static trunk flexion working postures and disturbed trunk muscle reflexes are related to increased risk of low-back pain. Animal studies conclude that these factors may be related; passive tissue strain in spinal ligaments causes subsequent short-term changes in reflex. Although studies have documented changes in the myoelectric onset angle of flexion-relaxation following prolonged static flexion and cyclic flexion we could find no published evidence related to the human reflex response of the trunk extensor muscles following a period of static flexion-relaxation loading.
Eighteen subjects maintained static lumbar flexion for 15 min. Paraspinal muscle reflexes were elicited both before and after the flexion-relaxation protocol using pseudorandom stochastic force disturbances while recording EMG. Reflex gain was computed from the peak value of the impulse response function relating input force perturbation to EMG response using time-domain deconvolution analyses.
Reflexes showed a trend toward increased gain after the period of flexion-relaxation (P < 0.055) and were increased with trunk extension exertion (P < 0.021). Significant gender differences in reflex gain were observed (P < 0.01).
Occupational activities requiring extended periods of trunk flexion contribute to changes in reflex behavior of the paraspinal muscles. Results suggest potential mechanisms by which flexed posture work may contribute to low-back pain. Significant gender differences indicate risk analyses should consider personal factors when considering neuromuscular behavior.
PMCID: PMC1630677  PMID: 15567532
Low-back; Reflex; Flexion-relaxation
21.  Effects of thrust amplitude and duration of high velocity low amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement 
Mechanical characteristics of high velocity low amplitude spinal manipulations (HVLA-SM) can be variable. Sustained changes in peripheral neuronal signaling due to altered load transmission to a sensory receptor’s local mechanical environment are often considered a mechanism contributing to the therapeutic effects of spinal manipulation. The purpose of this study was to determine whether an HVLA-SM’s thrust amplitude or duration altered neural responsiveness of lumbar muscle spindles to either vertebral movement or position.
Anesthetized cats (n=112) received L6 HVLA-SMs delivered to the spinous process. Cats were divided into 6 cohorts depending upon the peak thrust force (25%, 55%, 85% body weight) or thrust displacement (1, 2, 3mm) they received. Cats in each cohort received 8 thrust durations (0–250ms). Afferent discharge from 112 spindles was recorded in response to ramp and hold vertebral movement before and after the manipulation. Changes in mean instantaneous frequency (MIF) during the baseline period preceding the ramps (ΔMIFresting), during ramp movements (ΔMIFmovement), and with the vertebra held in the new position (ΔMIFposition) were compared.
Thrust duration had a small but statistically significant effect on ΔMIFresting at all six thrust amplitudes compared to control (0ms thrust duration). The lowest amplitude thrust displacement (1mm) increased ΔMIFresting at all thrust durations. For all the other thrust displacements and forces, the direction of change in ΔMIFresting was not consistent and the pattern of change was not systematically related to thrust duration. Regardless of thrust force, displacement, or duration, ΔMIFmovement and ΔMIFposition were not significantly different from control.
Relatively low amplitude thrust displacements applied during an HVLA-SM produced sustained increases in the resting discharge of paraspinal muscle spindles regardless of the duration over which the thrust was applied. However, regardless of the HVLA-SM’s thrust amplitude or duration, the responsiveness of paraspinal muscle spindles to vertebral movement and to a new vertebral position was not affected.
PMCID: PMC3752031  PMID: 23499141
spinal manipulation; dose; neurophysiology; paraspinal muscles; muscle spindle; Spine; Chiropractic
22.  Fusimotor control of spindle sensitivity regulates central and peripheral coding of joint angles 
Proprioceptive afferents from muscle spindles encode information about peripheral joint movements for the central nervous system (CNS). The sensitivity of muscle spindle is nonlinearly dependent on the activation of gamma (γ) motoneurons in the spinal cord that receives inputs from the motor cortex. How fusimotor control of spindle sensitivity affects proprioceptive coding of joint position is not clear. Furthermore, what information is carried in the fusimotor signal from the motor cortex to the muscle spindle is largely unknown. In this study, we addressed the issue of communication between the central and peripheral sensorimotor systems using a computational approach based on the virtual arm (VA) model. In simulation experiments within the operational range of joint movements, the gamma static commands (γs) to the spindles of both mono-articular and bi-articular muscles were hypothesized (1) to remain constant, (2) to be modulated with joint angles linearly, and (3) to be modulated with joint angles nonlinearly. Simulation results revealed a nonlinear landscape of Ia afferent with respect to both γs activation and joint angle. Among the three hypotheses, the constant and linear strategies did not yield Ia responses that matched the experimental data, and therefore, were rejected as plausible strategies of spindle sensitivity control. However, if γs commands were quadratically modulated with joint angles, a robust linear relation between Ia afferents and joint angles could be obtained in both mono-articular and bi-articular muscles. With the quadratic strategy of spindle sensitivity control, γs commands may serve as the CNS outputs that inform the periphery of central coding of joint angles. The results suggest that the information of joint angles may be communicated between the CNS and muscles via the descending γs efferent and Ia afferent signals.
PMCID: PMC3431011  PMID: 22969720
muscle spindle; γs control; spindle sensitivity; Ia afferents; joint angle; central and peripheral coding
23.  Disturbed Paraspinal Reflex Following Prolonged Flexion-Relaxation and Recovery 
Spine  2006;31(7):839-845.
Study Design.
Repeated measures experimental study of the effect of flexion-relaxation, recovery, and gender on paraspinal reflex dynamics.
To determine the effect of prolonged flexion-relaxation and recovery time on reflex behavior in human subjects.
Summary of Background Data.
Prolonged spinal flexion has been shown to disturb the paraspinal reflex activity in both animals and human beings. Laxity in passive tissues of the spine from flexion strain may contribute to desensitization of mechanoreceptors. Animal studies indicate that recovery of reflexes may take up to several hours. Little is known about human paraspinal reflex behavior following flexion tasks or the recovery of reflex behavior following the flexion tasks.
A total of 25 subjects performed static flexionrelaxation tasks. Paraspinal muscle reflexes were recorded before and immediately after flexion-relaxation and after a recovery period. Reflexes were quantified from systems identification analyses of electromyographic response in relation to pseudorandom force disturbances applied to the trunk.
Trunk angle measured during flexion-relaxation postures was significantly higher following static flexion-relaxation tasks (P < 0.001), indicating creep deformation of passive supporting structures in the trunk. Reflex response was diminished following flexion-relaxation (P < 0.029) and failed to recover to baseline levels during 16 minutes of recovery.
Reduced reflex may indicate that the spine is less stable following prolonged flexion-relaxation and, therefore, susceptible to injury. The absence of recovery in reflex after a substantial time indicates that increased low back pain risk from flexion-relaxation may persist after the end of the flexion task.
PMCID: PMC1808336  PMID: 16582860
flexion-relaxation; reflex; low back; spine; electromyogram; stability
24.  Modulatory Effects of α1-, α2-, and β-Receptor Agonists on Feline Spinal Interneurons with Monosynaptic Input from Group I Muscle Afferents 
Previous studies have shown that monoamines may modulate operation of spinal neuronal networks by depressing or facilitating responses of the involved neurons. Recently, activation of interneurons mediating reciprocal inhibition from muscle spindle (Ia) afferents and nonreciprocal inhibition from muscle spindle and tendon organ (Ia/Ib) afferents in the cat was found to be facilitated by noradrenaline (NA). However, which subclass membrane receptors are involved in mediating this facilitation was not established; the aim of the present experiments was to investigate this. Individual Ia- and Ia/Ib-inhibitory interneurons were identified in the cat lumbar spinal cord, and NA agonists were applied close to these neurons by ionophoresis. The agonists included the α1-receptor agonist phenylephrine, the α2-receptor agonists clonidine and tizanidine, and the β-receptor agonist isoproterenol. Effects were measured by comparing changes in the number of extracellularly recorded spike potentials evoked by electrical stimulation of muscle nerves and changes in the latency of these potentials before, during, and after application of the tested compounds. Results show that the facilitatory effect of phenylephrine is as strong as that of NA, whereas the facilitatory effect of isoproterenol is weaker. Clonidine depressed activity of both Ia- and Ia/Ib-inhibitory interneurons, whereas tizanidine had no effect. These findings lead to the conclusion that beneficial antispastic effects of clonidine and tizanidine in humans are unlikely to be associated with an enhancement of the actions of Ia- and Ia/Ib-inhibitory interneurons, and the findings also support previous proposals that these compounds exert their antispastic actions via effects on other neuronal populations.
PMCID: PMC1890035  PMID: 12514232
spinal cord; spinal reflexes; cat; group I afferents; spasticity; noradrenaline; clonidine; tizanidine; phenylephrine; isoproterenol
25.  A new phenotype of mitochondrial disease characterized by familial late-onset predominant axial myopathy and encephalopathy 
Acta Neuropathologica  2011;121(6):775-783.
Axial myopathy is a rare neuromuscular disease that is characterized by paraspinal muscle atrophy and abnormal posture, most notably camptocormia (also known as bent spine). The genetic cause of familial axial myopathy is unknown. Described here are the clinical features and cause of late-onset predominant axial myopathy and encephalopathy. A 73-year-old woman presented with a 10-year history of severe paraspinal muscle atrophy and cerebellar ataxia. Her 84-year-old sister also developed late-onset paraspinal muscle atrophy and generalized seizures with encephalopathy. Computed tomography showed severe atrophy and fatty degeneration of their paraspinal muscles. Their mother and maternal aunt also developed bent spines. The existence of many ragged-red fibers and cytochrome c oxidase-negative fibers in the biceps brachii muscle of the proband indicated a mitochondrial abnormality. No significant abnormalities were observed in the respiratory chain enzyme activities; however, the activities of complexes I and IV were relatively low compared with the activities of other complexes. Sequence analysis of the mitochondrial DNA from the muscle revealed a novel heteroplasmic mutation (m.602C>T) in the mitochondrial tRNAPhe gene. This familial case of late-onset predominant axial myopathy and encephalopathy may represent a new clinical phenotype of a mitochondrial disease.
PMCID: PMC3098999  PMID: 21424749
Mitochondrial disease; Predominant axial myopathy; Encephalopathy; Late-onset; Familial case

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