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Soft tissue texture analysis by B-mode-ultrasound in the evaluation of impairment in chronic low back pain
1Department of Traumatology, Hand- and Reconstructive Surgery, University of Ulm, Steinhovelstr. 9, 89075, Ulm/Donau, Germany.
Objective:
Patients complaints in chronic low back pain do not always correspond to the results of X-ray and MRI investigations. The paraspinal muscle is very sensitive to all structural disorders of the spine. We used B-mode-ultrasound to investigate the change of the ultrasonic texture of the paraspinal lumbar muscle in people suffering from low back pain.
Methods:
The quantitative texture analysis was defined by the ratio of the mean echo level of a unilateral cross-section (L2) of the paraspinal muscle and the level of a central area (L1) of the same cross-section (square 1 x 1 cm, defined by the ultrasonic device). In the lumbar spine there were five cross sections on either side starting at L1 through L5. In the first study healthy males were investigated (n=30). In the second study, 20 males with MRI controlled lumbar disc disorders were investigated. Finally screening was performed with a group of 40 male patients. The last investigation was a pathohistologic cross-check from the ultrasonic findings in five individual shortly after exitus.
Results:
The ratio showed results >0.6 in the healthy group. The group with lumbar disc disorders showed at the affected levels ratios <0.5. All patients (with one exception) with a lumbar spinal history were detected. Pathohistology confirmed the ultrasonic findings.
Conclusions:
The ultrasonic texture analysis of the paraspinal lumbar muscle allows a rapid and easy to perform investigation for relating discal (actually all structural) disorders of the lumbar spine to the reported pain or disability.