THE USE OF PERCUTANEOUS FINE NEEDLE BIOPSY TO DETERMINE PARASPINAL MUSCLE CONTRACTILE CHARACTERISTICS IN PATIENTS WITH LOW BACK PAIN: AN EXPLORATORY REVIEW

Abstract

Introduction Low back pain (LBP) is a highly prevalent and a major health problem in today’s western society. Several imaging studies have shown that lumbar paraspinal skeletal muscles in patients with chronic LBP demonstrate variations in morphology compared to healthy control patients1. Since there are some inconsistencies in the results of these studies, an exact knowledge of the alteration in fibre type structural characteristics and fibre type distribution of the lumbar paraspinal muscles in patients with LBP compared to healthy subjects is essential and need to be determined in muscle tissue. Skeletal muscle samples can be obtained during spinal surgery or by muscle biopsy.

Purpose/Aim The purpose of this review is to determine whether percutaneous fine needle skeletal muscle biopsy, also termed microbiopsy, could be used to examine muscle contractile characteristics in LBP patients.

Materials and Methods A literature search in PubMed and Web of Science was performed. A total of fifteen articles were found for quality analysis. Thirteen articles were included in this review. Data regarding the technical specifications of the biopsy procedure and data regarding the structural characteristics of the biopsy sample were extracted.

Results Percutaneous skeletal muscle microbiopsy is suitable to be used in interventional studies. Due to its small needle size (≥13 gauge) it is a minimal invasive technique. The pain caused by a microbiopsy is comparable to the pain caused by a venous injection. Therefore, the use of local anaesthesia is optional. In contrast to the most commonly used semi-open needle biopsy technique described by Bergström, a small skin incision is not necessary. The main disadvantage of fine needle biopsy technique is the small sample size for biochemical, histochemical and histomorphometric muscle analyses. However, the amount of muscle tissue obtained by microbiopsy to study fibre type characteristics is acceptable and tissue sample quality is excellent. Moreover, the amount of muscle tissue can be increased by repeated sampling. The results obtained with the fine needle technique are similar compared to other biopsy techniques (e.g. Bergström needle, Evans needle and open biopsy).

Conclusions The current study could not state any firm conclusions because the lack of high quality methodological studies. Although data extracted in this study, demonstrate the usefulness of the skeletal microbiopsy technique in determining contractile muscle characteristics. Moreover, the percutaneous fine needle technique appeared to be valid when compared to other muscle biopsy techniques.

Discussion Although no literature was found on using the fine needle biopsy technique in patients with LBP, it is likely that this technique is suitable for lumbar paraspinal muscle biopsy sampling in LBP patients, because it is a minimally invasive biopsy technique which appeared to be valid in other populations.