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Link to original content: http://www.ncbi.nlm.nih.gov/pubmed/19958536
Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain - PubMed Skip to main page content
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. 2009 Dec 3:10:151.
doi: 10.1186/1471-2474-10-151.

Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

Helene M Langevin  1 , Debbie Stevens-Tuttle, James R Fox, Gary J Badger, Nicole A Bouffard, Martin H Krag, Junru Wu, Sharon M Henry
Affiliations

Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

Helene M Langevin et al. BMC Musculoskelet Disord. .

Abstract

Background: Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.

Methods: In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.

Results: There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had approximately 25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p<0.01 and p<0.001 respectively).

Conclusion: This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.

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Figures

Figure 1
Figure 1
Ultrasound image acquisition method. A: location of ultrasound transducer relative to spine; B: anatomical cross-section showing structures imaged by ultrasound beam; C: example of parasagital ultrasound image showing location of dermis and muscle.
Figure 2
Figure 2
Ultrasound image analysis method. B: ultrasound image showing ROI (white box) and whisker lines corresponding to thickness of combined (red), subcutaneous (blue) and perimuscular (green) zones. Units on y axis represent cm. Arrow shows direction of ultrasound beam. A, C: ultrasound intensity profile corresponding to image in B. Colored areas highlight the area under the curve (used as measure of echogenicity) for combined (A, red area), perimuscular (C, green area) and subcutaneous (C, blue area) zones.
Figure 3
Figure 3
Echogenicity and thickness measurements for combined, subcutaneous and perimuscular zones. Open circles indicate No-LBP group and closed circles indicate LBP group; * p < 0.5, **p < .01, ***p < .001, ANCOVA adjusted for BMI (N = 107).
Figure 4
Figure 4
Examples of ultrasound images illustrating thin (A), thick (B) and multilayered (C) perimuscular connective tissue morphology.
See this image and copyright information in PMC

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