ArticlePain medicine (Malden, Mass.)2023
Multifidus dysfunction and restorative neurostimulation: a scoping review.
Article in Pain medicine (Malden, Mass.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 30 citations in OpenAlex.
- Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial.BMC musculoskeletal disorders · 2024Trial
- Clinical relevance of combined treatment with exercise in patients with chronic low back pain: a randomized controlled trial.Scientific reports · 2024Trial
- Article
- Effects of lumbar disc injury and nociception on trunk motor control during rat locomotion.Experimental brain research · 2026Article
- Electromyogram diagnosed chronic lumbar radiculopathy is highly associated with L4-S1 regional multifidus atrophy on magnetic resonance imaging.BMC musculoskeletal disorders · 2026Article
- Letter to the Editor Re: "Lumbar multifidus muscle morphology on MRI after restorative neurostimulation for chronic low back pain: a single centre case series using the Goutallier classification" by Whittle et al. (Eur Spine J [2026]: DOI: 10.1007/s00586-026-09863-8).European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- The association of lumbar paraspinal muscle size and quality with physical function, disability, and pain in adults with chronic low back pain.JOSPT open · 2026Article
- Conditioned pain modulation, cortical imbalance, and arthrogenic muscle inhibition: an integrative model with implications for exercise in chronic pain.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- Development and validation of a CT-based predictive model for new vertebral compression fractures: the role of vertebral CT attenuation and paraspinal muscle.Frontiers in medicine · 2026Article
- Semi-quantitative assessment of paraspinal muscle fat infiltration in single-level C5-6 cervical spondylosis using gray-level thresholding on conventional MRI: associations with disc degeneration and posture-related segmental angular change.Frontiers in medicine · 2026Article
- The effect of baseline spinal magnetic resonance imaging features on restorative neurostimulation efficacy in patients with chronic low back pain.Journal of spine surgery (Hong Kong) · 2025Article
- ISASS Recommendations and Coverage Criteria for Restorative Neurostimulation for Multifidus Dysfunction, Lumbar Region: Coverage Indications, Limitations, and/or Medical Necessity-An ISASS 2025 Guideline Update.International journal of spine surgery · 2025Article
- Isolated lumbar extension exercise alone or in a multimodal program for low back pain and radiculopathy: a non-randomized controlled trial.Scientific reports · 2025Article
- Evidence of Multifidus Changes Post-Lumbar Radiofrequency Ablation: A Narrative Literature Review.Journal of clinical medicine · 2025Review
- Multifidus Fat Infiltration in Patients with Persistent Spinal Pain Syndrome Type II Treated with Spinal Cord Stimulation: A Preliminary Report.Journal of clinical medicine · 2025Article
- Integrating Ultrasound-Guided Injections and Peripheral Magnetic Stimulation in Chronic Myofascial/Lumbar Pain.Life (Basel, Switzerland) · 2025Article
- Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up.Regional anesthesia and pain medicine · 2025Article
- Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction.Pain and therapy · 2025Article
- Consensus Guidelines for the Use of Peripheral Nerve Stimulation in the Treatment of Chronic Pain and Neurological Diseases: A Neuron Project from the American Society of Pain and Neuroscience.Journal of pain research · 2025Article
- Sequential Bilateral Peripheral Nerve Stimulation of Lumbar Medial Branches Following Laminectomy: A Case Report.Cureus · 2024Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveChronic 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.
methodsA scoping review of the literature.
resultsIn 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.
conclusionsMultifidus 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.