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Letter to the Editor Re: "Lumbar multifidus muscle morphology on MRI after restorative neurostimulation for chronic low back pain: a single centre case series using the Goutallier classification" by Whittle et al. (Eur Spine J [2026]: DOI: 10.1007/s00586-026-09863-8).

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Multifidus dysfunction and restorative neurostimulation: a scoping review.

Vinicius Tieppo Francio1,2, Benjamin D Westerhaus3, Alexios G Carayannopoulos4

  • 1Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States.

Pain Medicine (Malden, Mass.)
|July 13, 2023
PubMed
Summary

Restorative neurostimulation offers a novel treatment for chronic low back pain (CLBP) caused by multifidus dysfunction. This approach targets neuromuscular control to alleviate pain and improve function.

Keywords:
chronic low back painlumbar medial branch nervemultifidusneuromodulationneuromuscular controlperipheral nerve stimulationrestorative neurostimulationsensorimotor control

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Area of Science:

  • Neuroscience
  • Orthopedics
  • Rehabilitation Medicine

Background:

  • Chronic low back pain (CLBP) is often multifactorial, with multifidus dysfunction implicated in a subset of cases.
  • Multifidus dysfunction involves loss of neuromuscular control, leading to altered movement patterns, muscle inhibition, and potential atrophy.
  • Understanding the pathophysiology of multifidus dysfunction is crucial for developing targeted CLBP treatments.

Purpose of the Study:

  • To elucidate the pathophysiological cascade of multifidus dysfunction.
  • To differentiate multifidus dysfunction from other CLBP etiologies.
  • To explore the role of restorative neurostimulation in treating multifidus dysfunction.

Main Methods:

  • A comprehensive scoping review of the existing literature was conducted.
  • 194 relevant articles were included in the analysis.
  • Findings were synthesized to highlight emerging principles of multifidus dysfunction and restorative neurostimulation.

Main Results:

  • Multifidus dysfunction is characterized by mechanical, axial, nociceptive CLBP and functional lumbar instability, distinct from structural causes.
  • Diagnostic imaging can assess multifidus atrophy and other spinal pathologies.
  • Restorative neurostimulation differs from traditional methods by targeting a distinct etiology, anatomical site, and mechanism of action.

Conclusions:

  • Multifidus dysfunction arises from impaired neuromuscular control, potentially leading to atrophy and CLBP.
  • Restorative neurostimulation, an implantable system, stimulates the lumbar medial branch nerve to induce multifidus contractions.
  • This intervention aims to restore neuromuscular control, reduce pain and disability, and improve quality of life in CLBP patients.