Article Text

Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review
  1. Shilpa Purushotham1,2,
  2. Robert Stanley Stephenson2,
  3. Andy Sanderson1,3,
  4. Deborah Falla1
  1. 1Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2Anatomy Department, Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  3. 3Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Professor Deborah Falla; d.falla{at}


Introduction Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP.

Methods/analysis This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

Ethics and dissemination The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated.

PROSPERO registration number CRD42020198087.

  • anatomy
  • histopathology
  • rehabilitation medicine
  • back pain
  • spine

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  • Contributors All authors formulated the focus of the systematic review. SP is a PhD student and DF (lead supervisor) and RSS are supervisors. SP drafted the initial version of the protocol manuscript with DF, RSS and AS all providing guidance on topic, methodology and analyses. All authors reviewed and commented on each draft of the protocol. All authors have approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.