title: Muscle atrophy and changes in spinal morphology: is the lumbar spine vulnerable after prolonged bed-rest?
abstract: METHODS
  prospective longitudinal study.
  
  
  OBJECTIVE
  to evaluate the effect of bed-rest on the lumbar musculature and soft-tissues.
  
  
  BACKGROUND
  earlier work has suggested that the risk of low back injury is higher after overnight bed-rest or spaceflight. Changes in spinal morphology and atrophy in musculature important in stabilizing the spine could be responsible for this, but there are limited data on how the lumbar musculature and vertebral structures are affected during bed-rest.
  
  
  METHODS
  nine male subjects underwent 60-days head-down tilt bed-rest as part of the second Berlin Bed-Rest Study. Disc volume, intervertebral spinal length, intervertebral lordosis angle, and disc height were measured on sagittal plane magnetic resonance images. Axial magnetic resonance images were used to measure cross-sectional areas (CSAs) of the multifidus (MF), erector spinae, quadratus lumborum, and psoas from L1 to L5. Subjects completed low back pain (LBP) questionnaires for the first 7-days after bed-rest.
  
  
  RESULTS
  increases in disc volume, spinal length (greatest at lower lumbar spine), loss of the lower lumbar lordosis, and move to a more lordotic position at the upper lumbar spine (P < 0.0097) were seen. The CSAs of all muscles changed (P < 0.002), with the rate of atrophy greatest at L4 and L5 in MF (P < 0.002) and at L1 and L2 in the erector spinae (P = 0.0006). Atrophy of the quadratus lumborum was consistent throughout the muscle (P = 0.15), but CSA of psoas muscle increased (P < 0.0001). Subjects who reported LBP after bed-rest showed, before reambulation, greater increases in posterior disc height, and greater losses of MF CSA at L4 and L5 than subjects who did not report pain (all P < 0.085).
  
  
  CONCLUSIONS
  these results provide evidence that changes in the lumbar discs during bed-rest and selective atrophy of the MF muscle may be important factors in the occurrence of LBP after prolonged bed-rest.
authors.affiliation: Centre for Muscle & Bone Research, Charite Campus Benjamin Franklin, Free University & Humboldt University, Berlin, Germany. belavy@gmail.com
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Belavý
authors.forename: Gabriele
authors.initials: G
authors.lastname: Armbrecht
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Richardson
authors.forename: Dieter
authors.initials: D
authors.lastname: Felsenberg
authors.forename: Julie A
authors.initials: JA
authors.lastname: Hides
mesh_terms: D000328:Adult; D001510:Bed Rest; D018475:Head-Down Tilt / Q000502:physiology; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology; D017116:Low Back Pain / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009133:Muscular Atrophy / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D013131:Spine / Q000473:pathology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors