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Comparison of Lumbar Muscle Morphology in Patients With Chronic Nonspecific Low Back Pain With and Without Clinical Lumbar Segmental Instability

Faranak Mahmoudi Alami, Mohammad Taghipour, Ghadamali Talebi, Payam Sa’adat, Tahere Seyedhoseinpoor, Hamid Vahidi Rad, Sorayya Khafri


Evaluation of spinal muscle morphology may be critical because of its impact on segmental stability and control of the lumbar spine in the subset of patients with clinical lumbar segmental instability (LSI). The purpose of this study was to compare lumbar muscle morphology in CNLBP patients with clinical LSI, CNLBP patients without clinical LSI.


Low back pain (LBP) is one of the most common musculoskeletal disorders, and its prevalence is increasing daily due to aging and population growth [1]. There are several causes of LBP, but in 90% of the cases there is no specific pathology, which is referred to as non-specific LBP [2]. Clinical lumbar segmental instability (LSI) is a type of chronic non-specific LBP (CNLBP). It accounts for 30–35% of the cases of CNLBP [3]. Lumbar segmental instability is defined as a significant reduction in the ability of the spinal stabilizing system to maintain the neutral zone within the physiologic range so that there is no neurologic dysfunction, major deformity, or disabling pain [3,4].

Materials and method

The sample size for this case-control study was determined using Gpower software according to the study by D’Hooge et al [9], considering a 4-point difference for muscle-to-fat infiltration indices with a confidence level of 95% and a power of 80%, and was calculated to be 15 for each group of patients and then 15 healthy subjects as a control group. Fifteen patients with CNLBP (9 females and 6 males) with aged 18 to 45 years with symptoms and signs of clinical LSI and fifteen patients with CNLBP without clinical LSI (7 females and 8 males) participated. Fifteen individuals with no history of LBP (7 females and 8 males) also participated as a control group.


Forty-five subjects were allocated into 3 groups of CNLPB patients with clinical LSI, CNLBP patients without clinical LSI and individuals without LBP. Table 1 represented each group characteristics (Study dataset in S1 Appendix).


This study showed that lumbar MF muscle atrophied with both decreased muscle size and increased muscle fat infiltration at L3-L4 to L5-S1 in CNLBP with or without clinical signs of LSI. In addition, the lumbar ES was hypertrophied at a single lumbar level (L4-L5 level) only in CNLBP patients with LSI. The PM muscle did not show any morphological changes in the CNLBP patients, either in those with LSI or in those without LSI.


The authors of this article would like to thank Babol University of Medical Sciences for all the support.

Citation: Mahmoudi Alami F, Taghipour M, Talebi G, Sa’adat P, Seyedhoseinpoor T, Rad HV, et al. (2024) Comparison of lumbar muscle morphology in patients with chronic nonspecific low back pain with and without clinical lumbar segmental instability. PLoS ONE 19(4): e0301726.

Editor: Ravi Shankar Yerragonda Reddy, King Khalid University, SAUDI ARABIA

Received: December 16, 2023; Accepted: March 21, 2024; Published: April 4, 2024

Copyright: © 2024 Mahmoudi Alami et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


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