TY - JOUR
T1 - Multifidus dysfunction and restorative neurostimulation
T2 - a scoping review
AU - Francio, Vinicius Tieppo
AU - Westerhaus, Benjamin D.
AU - Carayannopoulos, Alexios G.
AU - Sayed, Dawood
N1 - Publisher Copyright:
VC The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Objective: Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. Methods: A scoping review of the literature. Results: In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. Conclusions: Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
AB - Objective: Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. Methods: A scoping review of the literature. Results: In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. Conclusions: Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
KW - chronic low back pain
KW - lumbar medial branch nerve
KW - multifidus
KW - neuromodulation
KW - neuromuscular control
KW - peripheral nerve stimulation
KW - restorative neurostimulation
KW - sensorimotor control
UR - http://www.scopus.com/inward/record.url?scp=85178651353&partnerID=8YFLogxK
U2 - 10.1093/pm/pnad098
DO - 10.1093/pm/pnad098
M3 - Review article
C2 - 37439698
AN - SCOPUS:85178651353
SN - 1526-2375
VL - 24
SP - 1341
EP - 1354
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
IS - 12
ER -