Keywords:
Surgery, Ablation procedures, MR, Neuroradiology spine, Musculoskeletal spine, Arthritides
Authors:
M. Bonython1, T. Nottage2, L. Xu2, M. Zotti2, T. Fisher2, M. Selby2; 1NT/AU, 2SA/AU
DOI:
10.26044/ranzcr2019/R-0092
Conclusion
This is the first prospective study in humans of MRI morphology of lumbar paraspinal muscles following clinically successful bilateral RFJD.
We found that patients who underwent bilateral RFJD had significant, moderate atrophy of their multifidus muscles by way of total size at both levels investigated and a change in composition at one of the two levels, where muscle fibres were replaced with fat. Neither size nor composition of erector spinae was significantly affected by surgery. Degree of spinal canal stenosis, neuroforaminal stenosis, disc and facet joint degeneration had no significant effect on degree of change of size of paraspinal musculature.
Limitations of this study relate to the fact that patients were only enrolled from a single centre and procedures were performed by a single operator. Further useful information could be obtained by direct assessment of any change in patients' subjective LBP over the same time points.
We have demonstrated a link between facet joint denervation and multifidus atrophy and, given that previous literature has shown that atrophy and fat infiltration of multifidus is strongly associated with LBP in adults, it is possible that facet joint denervation could be directly linked to low back pain although further research would be required to establish this.
Given how important a contributor multifidus is to the stability of the lumbar neutral zone and the association between facet joint denervation and multifidus atrophy, more judicious use of RFJD in patients with facetogenic LBP is required.