51
|
Gadermayr M, Li K, Müller M, Truhn D, Krämer N, Merhof D, Gess B. Domain-specific data augmentation for segmenting MR images of fatty infiltrated human thighs with neural networks. J Magn Reson Imaging 2019; 49:1676-1683. [PMID: 30623506 DOI: 10.1002/jmri.26544] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fat-fraction has been established as a relevant marker for the assessment and diagnosis of neuromuscular diseases. For computing this metric, segmentation of muscle tissue in MR images is a first crucial step. PURPOSE To tackle the high degree of variability in combination with the high annotation effort for training supervised segmentation models (such as fully convolutional neural networks). STUDY TYPE Prospective. SUBJECTS In all, 41 patients consisting of 20 patients showing fatty infiltration and 21 healthy subjects. Field Strength/Sequence: The T1 -weighted MR-pulse sequences were acquired on a 1.5T scanner. ASSESSMENT To increase performance with limited training data, we propose a domain-specific technique for simulating fatty infiltrations (i.e., texture augmentation) in nonaffected subjects' MR images in combination with shape augmentation. For simulating the fatty infiltrations, we make use of an architecture comprising several competing networks (generative adversarial networks) that facilitate a realistic artificial conversion between healthy and infiltrated MR images. Finally, we assess the segmentation accuracy (Dice similarity coefficient). STATISTICAL TESTS A Wilcoxon signed rank test was performed to assess whether differences in segmentation accuracy are significant. RESULTS The mean Dice similarity coefficients significantly increase from 0.84-0.88 (P < 0.01) using data augmentation if training is performed with mixed data and from 0.59-0.87 (P < 0.001) if training is conducted with healthy subjects only. DATA CONCLUSION Domain-specific data adaptation is highly suitable for facilitating neural network-based segmentation of thighs with feasible manual effort for creating training data. The results even suggest an approach completely bypassing manual annotations. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3.
Collapse
Affiliation(s)
- Michael Gadermayr
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany.,Salzburg University of Applied Sciences, Salzburg, Austria
| | - Kexin Li
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Madlaine Müller
- Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
| | - Daniel Truhn
- Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Nils Krämer
- Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Dorit Merhof
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Burkhard Gess
- Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
| |
Collapse
|
52
|
Farrell SF, Stanwell P, Cornwall J, Osmotherly PG. Quantitative magnetic resonance imaging assessment of lateral atlantoaxial joint meniscoid composition: a validation study. 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 2019; 28:1180-1187. [PMID: 30604294 DOI: 10.1007/s00586-018-05868-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Lateral atlantoaxial (LAA) joint meniscoid composition may have clinical significance in patients following neck trauma. However, the existing method of radiologically assessing meniscoid composition has an inherent element of subjectivity, which could contribute to measurement variability. The present study sought to investigate the accuracy of two-point Dixon fat/water separation MRI as a quantitative assessment of LAA joint meniscoid composition. METHODS Sixteen LAA joint meniscoids were excised from four cadavers (mean [SD] age 79.5 [3.7] years; one female) following cervical spine MRI (two-point Dixon, T1-weighted VIBE and T2-weighted SPACE sequences). Composition of LAA joint meniscoids was undertaken by (1) histological examination by light microscopy, (2) calculation of fat fraction by Dixon MRI (both in-phase/opposed-phase and fat/water methods), and (3) the existing method of considering VIBE and SPACE signal intensities. Analysis was performed using the kappa statistic with linear weighting. RESULTS Microscopy revealed three, five, and eight meniscoids to be composed of adipose, fibroadipose, and fibrous tissues, respectively. Dixon sequence MRI classified 11 of these meniscoids correctly, with 'substantial' level of agreement (In-phase/Opp-phase kappa statistic = 0.78 [95% CI 0.38, 1.17]; fat/water kappa statistic = 0.72 [95% CI 0.32, 1.11]). Level of agreement between microscopy and the VIBE and SPACE method was 'slight' (kappa statistic = 0.02 [95% CI - 0.34, 0.38]). CONCLUSIONS Findings suggest that Dixon fat/water separation MRI may have superior utility in the assessment of LAA joint meniscoid composition than the existing method of considering VIBE and SPACE signal intensities. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. .,RECOVER Injury Research Centre, Level 7 Oral Health Building, The University of Queensland, Herston Campus, Herston, 4006, QLD, Australia.
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,Institute for Health Sciences, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| |
Collapse
|
53
|
Precision implantation with positional confirmation of fine-wire EMG electrodes in the deep posterior neck muscles. J Electromyogr Kinesiol 2018; 43:162-167. [DOI: 10.1016/j.jelekin.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023] Open
|
54
|
Blomgren J, Strandell E, Jull G, Vikman I, Röijezon U. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord 2018; 19:415. [PMID: 30486819 PMCID: PMC6263552 DOI: 10.1186/s12891-018-2324-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Neck pain is a major health issue with high rates of recurrence. It presents with a variety of altered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods are used. Exercise is evaluated in most randomized controlled trials on its pain relieving effects. No review has assessed the effect of exercise on the altered physiological functions or determined if there are differential effects of particular training methods. This review investigated the effects of deep cervical flexor (DCF) training, a training method commonly used for patients with neck pain, and compared it to other training methods or no training on outcomes of cervical neuromuscular function, muscle size, kinematics and kinetics. Methods Web of Science, Scopus, CINAHL, PubMed were searched from inception until January 2018. Twelve randomized controlled trials were included that compared DCF training as sole intervention to other training or no interventions in persons with neck pain. The Cochrane Risk of Bias tool was used to assess the method quality. All outcome measures were analysed descriptively and meta-analyses were performed for measures evaluated in three or more studies. Results DCF training was compared to cervical endurance, strength, proprioception and mobility training, muscle stretching, and no intervention control groups. Physiological outcome measures included neuromuscular co-ordination (craniocervical flexion test), functional tasks, muscle fatigability, muscle size, kinematics (joint position sense, posture and range of motion) and kinetics (strength, endurance and contraction accuracy). Strong evidence was found for effectiveness of DCF training on neuromuscular coordination, but it had no or small effects on strength and endurance at higher loads. DCF training improved head and cervical posture, while evidence was limited or contradictory for other measures. Conclusions DCF training can successfully address impaired neuromuscular coordination, but not cervical flexor strength and endurance at higher contraction intensities. A multimodal training regime is proposed when the aim is to specifically address various impaired physiological functions associated with neck pain.
Collapse
Affiliation(s)
- Johannes Blomgren
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Erika Strandell
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Gwendolen Jull
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Irene Vikman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
| |
Collapse
|
55
|
Cloney M, Smith AC, Coffey T, Paliwal M, Dhaher Y, Parrish T, Elliott J, Smith ZA. Fatty infiltration of the cervical multifidus musculature and their clinical correlates in spondylotic myelopathy. J Clin Neurosci 2018; 57:208-213. [DOI: 10.1016/j.jocn.2018.03.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/21/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
|
56
|
Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:754-772. [PMID: 30168261 DOI: 10.1111/1742-6723.13131] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/14/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Abstract
Neck pain and whiplash injuries are a common presentation to the ED, and a frequent cause of disability globally. This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years addressing acute neck pain assessment, management or prognosis in the ED were included. Data extraction was conducted, followed by quality appraisal to rate levels of evidence where possible. The search revealed 2080 articles, of which 51 were included (n = 22 primary articles, n = 13 systematic reviews and n = 16 guidelines). Consistent evidence was found to support the use of 'red flags' to screen for serious pathologies, judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance. Clinicians may also consider applying risk-stratification methods, such as using a clinical prediction rule, to guide patient discharge and referral plans; however, the evidence is still emerging in this population. This rapid review provides clinicians managing neck pain in the ED a summary of the best available evidence to enhance quality of care and optimise patient outcomes.
Collapse
Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
57
|
Rao PJ, Chau C, Phan K, Mobbs RJ. Degenerate-disc Infection Study with Contaminant Control: Discussion on the Research Methods. Orthop Surg 2018; 10:64-68. [PMID: 29484856 DOI: 10.1111/os.12366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The role of bacterial infection in the causation of disc degeneration and its consequences is controversial. The current evidence is limited to underpowered studies, with the majority of such studies having only an internal contaminant arm, and only one study having a control arm with a non-degenerate disc population. The Degenerate-disc Infection Study with Contaminant Control (DISC) study includes a control arm and an internal contaminant control to resolve these shortcomings. METHODS The study is designed as a case-control study: cases are patients undergoing surgery for degenerated disc pathology and controls are patients undergoing surgery for non-degenerate pathology, such as trauma, scoliosis or tumor cases. RESULTS This study is part of a multi-centric trial involving six spine centers with 15 spine surgeons contributing. The DISC study methodology, rationale and controversies are presented here. The predominant issue is how to interpret contamination. We present our algorithm for the DISC study to address this. For disc samples that are positive concurrently with positive paraspinal tissue sample, the result will be interpreted as contamination. For positive disc samples with a negative paraspinal tissue culture result, the interpretation of this result will be infection. If cultures for both disc sample and paraspinal tissue sample are negative, then the result is interpreted as non-infected. If the disc culture is negative but paraspinal tissue culture is positive, then it is treated as a contaminant. CONCLUSIONS Future large-scale studies are required with a good control arm, a contamination arm, and histopathological correlations.
Collapse
Affiliation(s)
- Prashanth J Rao
- NeuroSpineClinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Christine Chau
- Department of Microbiology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Kevin Phan
- NeuroSpineClinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia.,University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Ralph J Mobbs
- NeuroSpineClinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,University of New South Wales (UNSW), Sydney, New South Wales, Australia
| |
Collapse
|
58
|
Elliott JM, Hancock MJ, Crawford RJ, Smith AC, Walton DM. Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury. Spine J 2018; 18:1489-1497. [PMID: 28774580 PMCID: PMC6874915 DOI: 10.1016/j.spinee.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings. PURPOSE This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes. STUDY DESIGN/SETTING A non-systematic review of the literature is carried out. METHODS A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided. RESULTS An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain. CONCLUSIONS Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.
Collapse
Affiliation(s)
- James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1100, Chicago, IL, USA; School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia
| | - Rebecca J Crawford
- Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Andrew C Smith
- Regis University School of Physical Therapy, 3333 Regis Boulevard, Denver, CO 80221, USA
| | - David M Walton
- School of Physical Therapy, Western University, Room 1588, London, Ontario N6G 1H1, Canada
| |
Collapse
|
59
|
Schlaeger S, Inhuber S, Rohrmeier A, Dieckmeyer M, Freitag F, Klupp E, Weidlich D, Feuerriegel G, Kreuzpointner F, Schwirtz A, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC, Baum T. Association of paraspinal muscle water-fat MRI-based measurements with isometric strength measurements. Eur Radiol 2018; 29:599-608. [PMID: 30014202 DOI: 10.1007/s00330-018-5631-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Chemical shift encoding-based water-fat MRI derived proton density fat fraction (PDFF) of the paraspinal muscles has been emerging as a surrogate marker in subjects with sarcopenia, lower back pain, injuries and neuromuscular disorders. The present study investigates the performance of paraspinal muscle PDFF and cross-sectional area (CSA) in predicting isometric muscle strength. METHODS Twenty-six healthy subjects (57.7% women; age: 30 ± 6 years) underwent 3T axial MRI of the lumbar spine using a six-echo 3D spoiled gradient echo sequence for chemical shift encoding-based water-fat separation. Erector spinae and psoas muscles were segmented bilaterally from L2 level to L5 level to determine CSA and PDFF. Muscle flexion and extension maximum isometric torque values [Nm] at the back were measured with an isokinetic dynamometer. RESULTS Significant correlations between CSA and muscle strength measurements were observed for erector spinae muscle CSA (r = 0.40; p = 0.044) and psoas muscle CSA (r = 0.61; p = 0.001) with relative flexion strength. Erector spinae muscle PDFF correlated significantly with relative muscle strength (extension: r = -0.51; p = 0.008; flexion: r = -0.54; p = 0.005). Erector spinae muscle PDFF, but not CSA, remained a statistically significant (p < 0.05) predictor of relative extensor strength in multivariate regression models (R2adj = 0.34; p = 0.002). CONCLUSIONS PDFF measurements improved the prediction of paraspinal muscle strength beyond CSA. Therefore, chemical shift encoding-based water-fat MRI may be used to detect subtle changes in the paraspinal muscle composition. KEY POINTS • We investigated the association of paraspinal muscle fat fraction based on chemical shift encoding-based water-fat MRI with isometric strength measurements in healthy subjects. • Erector spinae muscle PDFF correlated significantly with relative muscle strength. • PDFF measurements improved prediction of paraspinal muscle strength beyond CSA.
Collapse
Affiliation(s)
- Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Stephanie Inhuber
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Alexander Rohrmeier
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friedemann Freitag
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elisabeth Klupp
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Feuerriegel
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Kreuzpointner
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ansgar Schwirtz
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
60
|
Elliott JM, Cornwall J, Kennedy E, Abbott R, Crawford RJ. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskelet Disord 2018; 19:171. [PMID: 29807530 PMCID: PMC5972401 DOI: 10.1186/s12891-018-2074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.
Collapse
Affiliation(s)
- James M Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Australia 75 East Street Lidcombe NSW, Sydney, 2141, Australia. .,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Honorary Fellow School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | |
Collapse
|
61
|
Pedler A, McMahon K, Galloway G, Durbridge G, Sterling M. Intramuscular fat is present in cervical multifidus but not soleus in patients with chronic whiplash associated disorders. PLoS One 2018; 13:e0197438. [PMID: 29795590 PMCID: PMC5967697 DOI: 10.1371/journal.pone.0197438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
The presence of intramuscular fat (IMF) in the cervical spine muscles of patients with whiplash associated disorders (WAD) has been consistently found. The mechanisms underlying IMF are not clear but preliminary evidence implicates a relationship with stress system responses. We hypothesised that if systemic stress system responses do play a role then IMF would be present in muscles remote to the cervical spine. We aimed to investigate if IMF are present in muscle tissue remote (soleus) to the cervical spine in people with chronic WAD. A secondary aim was to investigate associations between IMF and posttraumatic stress symptom levels. Forty-three people with chronic WAD (25 female) and 16 asymptomatic control participants (11 female) participated. Measures of pain, disability and posttraumatic stress symptoms were collected from the WAD participants. Both groups underwent MRI measures of IMF in cervical multifidus and the right soleus muscle. There was significantly greater IMF in cervical multifidus in patients with WAD and moderate/severe disability compared to controls (p = 0.009). There was no difference in multifidus IMF between the mild and moderate/severe disability WAD groups (p = 0.64), or the control and mild WAD groups (p = 0.21). IMF in the right soleus was not different between the groups (p = 0.47). In the WAD group, we found no correlation between PDS symptoms and cervical multifidus IMF or between PDS symptoms and soleus IMF. Global differences in IMF are not a feature of chronic WAD, with differences in IMF limited to the cervical spine musculature. While the mechanisms for the development of IMF in the cervical spine following whiplash injury remain unclear, our data indicate that local factors more likely contribute to these differences.
Collapse
Affiliation(s)
- Ashley Pedler
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injury, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Katie McMahon
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Gail Durbridge
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injury, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- * E-mail:
| |
Collapse
|
62
|
Kiefer LS, Fabian J, Lorbeer R, Machann J, Storz C, Kraus MS, Wintermeyer E, Schlett C, Roemer F, Nikolaou K, Peters A, Bamberg F. Inter- and intra-observer variability of an anatomical landmark-based, manual segmentation method by MRI for the assessment of skeletal muscle fat content and area in subjects from the general population. Br J Radiol 2018; 91:20180019. [PMID: 29658780 DOI: 10.1259/bjr.20180019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Changes in skeletal muscle composition, such as fat content and mass, may exert unique metabolic and musculoskeletal risks; however, the reproducibility of their assessment is unknown. We determined the variability of the assessment of skeletal muscle fat content and area by MRI in a population-based sample. METHODS A random sample from a prospective, community-based cohort study (KORA-FF4) was included. Skeletal muscle fat content was quantified as proton-density fat fraction (PDFF) and area as cross-sectional area (CSA) in multi-echo Dixon sequences (TR 8.90 ms, six echo times, flip angle 4°) by a standardized, anatomical landmark-based, manual skeletal muscle segmentation at level L3 vertebra by two independent observers. Reproducibility was assessed by intraclass correlation coefficients (ICC), scatter and Bland-Altman plots. RESULTS From 50 subjects included (mean age 56.1 ± 8.8 years, 60.0% males, mean body mass index 28.3 ± 5.2) 2'400 measurements were obtained. Interobserver agreement was excellent for all muscle compartments (PDFF: ICC0.99, CSA: ICC0.98) with only minor absolute and relative differences (-0.2 ± 0.5%, 31 ± 44.7 mm2; -2.6 ± 6.4% and 2.7 ± 3.9%, respectively). Intra-observer reproducibility was similarly excellent (PDFF: ICC1.0, 0.0 ± 0.4%, 0.4%; CSA: ICC1.0, 5.5 ± 25.3 mm2, 0.5%, absolute and relative differences, respectively). All agreement was independent of age, gender, body mass index, body height and visceral adipose tissue (ICC0.96-1.0). Furthermore, PDFF reproducibility was independent of CSA (ICC0.93-0.99). Conclusions: Quantification of skeletal muscle fat content and area by MRI using an anatomical landmark-based, manual skeletal muscle segmentation is highly reproducible. Advances in knowledge: An anatomical landmark-based, manual skeletal muscle segmentation provides high reproducibility of skeletal muscle fat content and area and may therefore serve as a robust proxy for myosteatosis and sarcopenia in large cohort studies.
Collapse
Affiliation(s)
- Lena Sophie Kiefer
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany
| | - Jana Fabian
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany
| | - Roberto Lorbeer
- 2 Department of Radiology, Ludwig-Maximilian-University Hospital , Munich , Germany
| | - Jürgen Machann
- 3 Department of Diagnostic and Interventional Radiology, Section of Experimental Radiology, University of Tuebingen , Tuebingen , Germany.,4 Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tuebingen , Tuebingen , Germany.,5 German Center for Diabetes Research (DZD) , Neuherberg , Germany
| | - Corinna Storz
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany
| | - Mareen Sarah Kraus
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany
| | - Elke Wintermeyer
- 6 BG Trauma Center, University of Tuebingen , Tuebingen , Germany
| | - Christopher Schlett
- 7 Department of Radiology, Diagnostic and Interventional Radiology, University of Heidelberg , Heidelberg , Germany
| | - Frank Roemer
- 8 Department of Radiology, University of Erlangen-Nuremberg , Erlangen , Germany
| | - Konstantin Nikolaou
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany
| | - Annette Peters
- 9 German Center for Cardiovascular Disease Research (DZHK e.V.) , Munich , Germany.,10 Institute for Cardiovascular Prevention, Ludwig-Maximilian-University-Hospital , Munich , Germany.,11 Institute of Epidemiology II, Helmholtz Zentrum Munich, German Research Center for Environmental Health , Neuherberg , Germany
| | - Fabian Bamberg
- 1 Department of Diagnostic and Interventional Radiology, University of Tuebingen , Tuebingen , Germany.,9 German Center for Cardiovascular Disease Research (DZHK e.V.) , Munich , Germany
| |
Collapse
|
63
|
Abbott R, Peolsson A, West J, Elliott JM, Åslund U, Karlsson A, Leinhard OD. The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging. Spine J 2018; 18:717-725. [PMID: 28887274 PMCID: PMC8845185 DOI: 10.1016/j.spinee.2017.08.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/30/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING This is a cross-sectional study. PATIENT SAMPLE Thirty-one subjects with WAD and 31 age- and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (p<.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice.
Collapse
Affiliation(s)
- Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Janne West
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV)/ Division of Radiological Services, IMH, Linköping University, SE-581 85 Linköping, Sweden
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA,School of Health and Rehabilitation Sciences, The University of Queensland, Australia,Zurich University of Applied Sciences, Gertrudstrasse 15, 8400 Winterthur, Switzerland
| | - Ulrika Åslund
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV)/ Department of Biomedical Engineering, Linköping University, SE 58183 Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization (CMIV)/Division of Radiological Sciences, IMH, Linköping University, SE-581 85 Linköping, Sweden.
| |
Collapse
|
64
|
Gadermayr M, Disch C, Müller M, Merhof D, Gess B. A comprehensive study on automated muscle segmentation for assessing fat infiltration in neuromuscular diseases. Magn Reson Imaging 2018; 48:20-26. [DOI: 10.1016/j.mri.2017.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 01/20/2023]
|
65
|
Hill L, Aboud D, Elliott J, Magnussen J, Sterling M, Steffens D, Hancock MJ. Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review. Spine J 2018; 18:880-891. [PMID: 29412188 DOI: 10.1016/j.spinee.2018.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear. PURPOSE We aimed to investigate whether findings on cervical spine MRI predict future neck pain. STUDY DESIGN A systematic review was carried out. PATIENT SAMPLE People with or without neck pain comprised the study sample. OUTCOME MEASURES Clinically important neck pain outcomes such as pain and disability. METHODS The review protocol was registered on PROSPERO [CRD42016049228]. MEDLINE, CINAHL, and EMBASE databases were searched. Prospective cohort studies investigating the association between baseline MRI findings and clinical outcome were included. Cohorts with serious underlying diseases as the cause of their neck pain were excluded. Associations between MRI findings and neck pain outcomes were extracted from the included studies. RESULTS A total of 12 studies met all inclusion criteria. Eight studies presented data on participants with current neck pain, two studies included a mixed sample, and two studies included a sample of participants with no current neck pain. Because of the heterogeneity between the studies in terms of MRI findings, populations, and clinical outcomes investigated, it was not possible to pool the results. No consistent associations between MRI findings and future outcomes were identified. Single studies of populations with neck pain reported significant associations for neck muscle fatty infiltrate (risk ratio [RR]: 21.00, 95% confidence interval [CI]: 2.97-148.31) with persistent neck disability; disc protrusion (mean difference ranged from -1.83 to -2.88 on a 10-point pain scale), and disc degeneration (RR: 0.59; 95% CI: 0.36-0.98) with neck pain. In a population without pain, the development of foraminal stenosis over a 10-year period was associated with development of neck pain (RR: 2.99; 95% CI: 1.23-7.23). CONCLUSION The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain.
Collapse
Affiliation(s)
- Laura Hill
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - David Aboud
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - James Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Sydney, 2065, Australia; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Magnussen
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - Michele Sterling
- Recover Injury Research Centre and Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, QLD 4072, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney Medical School, The Univeristy of Sydney, Sydney, NSW 2050, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia.
| |
Collapse
|
66
|
Kim N, Shin BC, Shin JS, Lee J, Lee YJ, Kim MR, Hwang EH, Jung CY, Ruan D, Ha IH. Characteristics and status of Korean medicine use in whiplash-associated disorder patients. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:124. [PMID: 29625626 PMCID: PMC5889578 DOI: 10.1186/s12906-018-2188-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Abstract
Background Patients are free to choose conventional or Korean medicine treatment under the dual medical system in Korea, and the prevalence of patients who choose Korean medicine treatment for whiplash-associated disorders (WADs) is high. This study analyzed the sociodemographic characteristics and medical service use in this population to provide healthcare providers with basic usage information of complementary and alternative medicine for WAD. Methods A total of 8291 outpatients who registered under automobile insurance coverage and visited the main branch of Jaseng Hospital of Korean Medicine from April 1, 2014 to August 10, 2016 were included. Data on sociodemographic characteristics, symptoms, and accident and treatment-related details were collected from electronic medical records. Univariate and multivariate regression analyses were performed to identify baseline factors predictive of total treatment duration. Results The most prevalent demographic of patients who chose Korean medicine for WAD treatment was males in their thirties whose initial visit to the hospital was 16.1 ± 94.1 days from the accident. Neck pain accompanied by low back pain (57.0%) was the most common complaint, and for singular pain, neck pain (13.5%) was the most prevalent. Baseline numeric rating scale (NRS) pain levels were generally moderate (4–6) regardless of area. Patients received 7.2 ± 10.2 sessions of treatment for 32.6 ± 55.3 days. The most commonly prescribed treatment modalities in order of highest frequency were acupuncture, cupping, pharmacopuncture, and herbal medicine, which collectively accounted for > 90% of treatments. Acupuncture was administered 29.0 ± 40.8 times, and cupping 14.0 ± 18.7 times as the two highest frequency treatments. In multivariate regression analysis, longer treatment periods were found to be associated with higher NRS, older age, and delayed initial visits at baseline. Conclusions This study highlights the characteristics and Korean medicine use of WAD patients. These results are particularly relevant and informative for consideration of personal preferences and effective prioritization in further insurance coverage.
Collapse
|
67
|
Owers DS, Perriman DM, Smith PN, Neeman T, Webb AL. Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis. Injury 2018; 49:165-176. [PMID: 29269107 DOI: 10.1016/j.injury.2017.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). RESULTS Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I2 = 83%). CONCLUSIONS The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry.
Collapse
Affiliation(s)
- Daniel S Owers
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia
| | - Diana M Perriman
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, ACT, 2605, Australia; Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
| | - Paul N Smith
- Australian Capital Territory Health, Canberra Hospital, Woden, ACT, 2605, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, ACT, 2605, Australia; Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, ACT, 2601, Australia
| | - Alexandra L Webb
- Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia.
| |
Collapse
|
68
|
Sollmann N, Dieckmeyer M, Schlaeger S, Rohrmeier A, Syvaeri J, Diefenbach MN, Weidlich D, Ruschke S, Klupp E, Franz D, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC, Baum T. Associations Between Lumbar Vertebral Bone Marrow and Paraspinal Muscle Fat Compositions-An Investigation by Chemical Shift Encoding-Based Water-Fat MRI. Front Endocrinol (Lausanne) 2018; 9:563. [PMID: 30323789 PMCID: PMC6172293 DOI: 10.3389/fendo.2018.00563] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose: Advanced magnetic resonance imaging (MRI) methods enable non-invasive quantification of body fat situated in different compartments. At the level of the lumbar spine, the paraspinal musculature is the compartment spatially and functionally closely related to the vertebral column, and both vertebral bone marrow fat (BMF) and paraspinal musculature fat contents have independently shown to be altered in various metabolic and degenerative diseases. However, despite their close relationships, potential correlations between fat compositions of these compartments remain largely unclear. Materials and Methods: Thirty-nine female subjects (38.5% premenopausal women, 29.9 ± 7.1 years; 61.5% postmenopausal women, 63.2 ± 6.3 years) underwent MRI at 3T of the lumbar spine using axially- and sagittally-prescribed gradient echo sequences for chemical shift encoding-based water-fat separation. The erector spinae muscles and vertebral bodies of L1-L5 were segmented to determine the proton density fat fraction (PDFF) of the paraspinal and vertebral bone marrow compartments. Correlations were calculated between the PDFF of the paraspinal muscle and bone marrow compartments. Results: The average PDFF of the paraspinal muscle and bone marrow compartments were significantly lower in premenopausal women when compared to postmenopausal women (11.6 ± 2.9% vs. 24.6 ± 7.1% & 28.8 ± 8.3% vs. 47.2 ± 8.5%; p < 0.001 for both comparisons). In premenopausal women, no significant correlation was found between the PDFF of the erector spinae muscles and the PDFF of the bone marrow of lumbar vertebral bodies (p = 0.907). In contrast, a significant correlation was shown in postmenopausal women (r = 0.457, p = 0.025). Significance was preserved after inclusion of age and body mass index (BMI) as control variables (r = 0.472, p = 0.027). Conclusion: This study revealed significant correlations between the PDFF of paraspinal and vertebral bone marrow compartments in postmenopausal women. The PDFF of the paraspinal and vertebral bone marrow compartments and their correlations might potentially serve as biomarkers; however, future studies including more subjects are required to evaluate distinct clinical value and reliability. Future studies should also follow up our findings in patients suffering from metabolic and degenerative diseases to clarify how these correlations change in the course of such diseases.
Collapse
Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- *Correspondence: Nico Sollmann
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Rohrmeier
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan Syvaeri
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian N. Diefenbach
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Elisabeth Klupp
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| |
Collapse
|
69
|
Peolsson A, Landén Ludvigsson M, Peterson G. Neck-specific exercises with internet-based support compared to neck-specific exercises at a physiotherapy clinic for chronic whiplash-associated disorders: study protocol of a randomized controlled multicentre trial. BMC Musculoskelet Disord 2017; 18:524. [PMID: 29233141 PMCID: PMC5727971 DOI: 10.1186/s12891-017-1853-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/15/2017] [Indexed: 01/18/2023] Open
Abstract
Background Globally, neck pain is the fourth most common condition associated with longer periods of living with disability. Annually, approximately 0.3% of the population of Western countries undergo whiplash trauma, and half of those individuals will develop chronic problems with high costs for the individual and society. Evidence for chronic whiplash-associated disorders (WAD) treatment is scarce, though neck-specific training at a physiotherapy clinic twice a week for 12 weeks has demonstrated good results. More efficient, flexible rehabilitation with reduced waiting times and lower costs is needed, ideally replacing lengthy on-site treatment series by healthcare providers. Internet-based care has been shown to be a viable alternative for a variety of diseases and interventions, but studies are lacking on Internet-based interventions for individuals with chronic neck problems. The aim of the trial described here is to compare the effects of an Internet-based neck-specific exercise programme to the same exercises performed at a physiotherapy clinic in regards to self-reported and clinical measures, as well as cost-effectiveness. Methods This prospective, randomized controlled trial will involve 140 participants. Measurements will be made at baseline, 3 months (end of treatment), and 15 months (12 months after end of intervention) and will include ratings of pain, disability, satisfaction with care, work ability, quality of life, and cost-effectiveness. Discussion The study results may contribute to the development of a more effective rehabilitation, flexible and equal care, shorter waiting times, increased availability, and lower costs for healthcare and society. Trial registration ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016.
Collapse
Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.
| | - Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.,Department of Rehabilitation and Department of Medical and Health Sciences, Rehab Väst, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| |
Collapse
|
70
|
Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J, Urquhart DM. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J 2017; 17:1729-1748. [PMID: 28756299 DOI: 10.1016/j.spinee.2017.07.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although previous studies have investigated the association between paraspinal muscle morphology and low back pain (LBP), the results are conflicting. PURPOSE This systematic review examined the relationship between size and composition of the paraspinal muscles and LBP. STUDY DESIGN/SETTING A systematic review was carried out. PATIENT SAMPLE No patient sample was required. OUTCOME MEASURES This review had no outcome measures. METHODS A systematic search of electronic databases was conducted to identify studies investigating the association between the cross-sectional area or fatty infiltration of the paraspinal muscles (erector spinae, multifidus, psoas, and quadratus lumborum) and LBP. Descriptive data regarding study design and methodology were tabulated and a risk of bias assessment was performed. RESULTS Of the 119 studies identified, 25 met the inclusion criteria. Eight studies were reported as having low to moderate risk of bias. There was evidence for a negative association between cross-sectional area (CSA) of multifidus and LBP, but conflicting evidence for a relationship between erector spinae, psoas, and quadratus lumborum CSA and LBP. Moreover, there was evidence to indicate multifidus CSA was predictive of LBP for up to 12 months in men, but insufficient evidence to indicate a relationship for longer time periods. Although there was conflicting evidence for a relationship between multifidus fat infiltration and LBP, there was no or limited evidence for an association for the other paraspinal musculature. CONCLUSIONS This review found evidence that multifidus CSA was negatively associated with and predictive of LBP up to 12 months but conflicting evidence for an association between erector spinae, psoas, and quadratus lumborum CSA and LBP. To further understand the role of the paraspinal musculature in LBP, there is a need for high-quality cohort studies which extend over both the short and longer term.
Collapse
Affiliation(s)
- Tom A Ranger
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Tue S Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Oestre Hougvej 55, 5500 Middelfart, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Waruna L Peiris
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Sultana Monira Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Jessica Fairley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| |
Collapse
|
71
|
Jin W, Sun X, Shen K, Wang J, Liu X, Shang X, Tao H, Zhu T. Recurrent Neurological Deterioration after Conservative Treatment for Acute Traumatic Central Cord Syndrome without Bony Injury: Seventeen Operative Case Reports. J Neurotrauma 2017; 34:3051-3057. [PMID: 27842476 DOI: 10.1089/neu.2016.4706] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wenjie Jin
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xin Sun
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kangping Shen
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jia Wang
- Shanghai Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingzhen Liu
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiushuai Shang
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hairong Tao
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Tong Zhu
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
72
|
Dahlqvist JR, Vissing CR, Hedermann G, Thomsen C, Vissing J. Fat Replacement of Paraspinal Muscles with Aging in Healthy Adults. Med Sci Sports Exerc 2017; 49:595-601. [PMID: 27741218 DOI: 10.1249/mss.0000000000001119] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The aims of this study were to investigate the age-related changes in fatty replacement and cross-sectional area (CSA) of cervical, thoracic, and lumbar paraspinal muscles versus leg muscles in healthy adults and to test for association between muscle fat fraction and lifestyle factors. METHODS Fifty-three healthy adults (24-76 yr) were included. Dixon magnetic resonance imaging technique was used to determine CSA and to quantify the fat fraction of paraspinal and leg muscles. Muscle CSA and fat fractions were tested for association with age and muscle strength. The fat fractions were also tested for association with sex, body mass index (BMI), physical activity, and lower back pain. RESULTS Both paraspinal and leg fat fractions correlated directly with age (P < 0.0001). At all ages, fat fraction was higher in paraspinal than leg muscles. The age-related increase in fat fraction was higher in paraspinal muscles than leg muscles (P < 0.0001). The CSA of the muscles did not correlate with age. Knee extension strength correlated with fat fraction (P < 0.05), and the muscle strength of hip muscles, thigh muscles, and anterior calf muscles correlated with CSA (P < 0.05). Sex was associated with lumbar paraspinal fat fraction (P < 0.05) and BMI with thigh fat fraction (P < 0.001). There was no association between fat fraction and physical activity or lower back pain. CONCLUSION The paraspinal muscles were more susceptible to age-related changes than leg muscles. Further, men had significantly lower fat fractions in lumbar paraspinal muscles, and BMI was positively associated with thigh, but not paraspinal, fat fraction.
Collapse
Affiliation(s)
- Julia R Dahlqvist
- 1Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK; and 2Department of Diagnostic Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | | | | | | | | |
Collapse
|
73
|
Yu B, Jiang K, Li X, Zhang J, Liu Z. Correlation of the Features of the Lumbar Multifidus Muscle With Facet Joint Osteoarthritis. Orthopedics 2017; 40:e793-e800. [PMID: 28585998 DOI: 10.3928/01477447-20170531-05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
Facet joint osteoarthritis is considered a consequence of the aging process; however, there is evidence that it may be associated with degenerative changes of other structures. The goal of this study was to investigate the correlation between lumbar multifidus muscle features and facet joint osteoarthritis. This retrospective study included 160 patients who had acute or chronic low back pain and were diagnosed with facet joint osteoarthritis on computed tomography scan. Morphometric parameters, including cross-sectional area, muscle-fat index, and percentage of bilateral multifidus asymmetry at L3-L4, L4-L5, and L5-S1, were evaluated with T2-weighted magnetic resonance imaging. Patients with facet joint osteoarthritis had a smaller cross-sectional area and a higher muscle-fat index than those without facet joint osteoarthritis (P<.001). In multivariate regression analysis, older age and higher muscle-fat index were independently associated with facet joint osteoarthritis at all 3 spinal levels (P<.001). Smaller cross-sectional area was independently associated with facet joint osteoarthritis only at L4-L5 (P=.005). Asymmetry of the bilateral multifidus cross-sectional area was independently associated with facet joint osteoarthritis at L5-S1 (P=.009), but did not seem to be responsible for asymmetric degeneration of the bilateral facet joints. A higher multifidus muscle-fat index was independently associated with facet joint osteoarthritis, and bilateral multifidus size asymmetry was associated with the development of facet joint osteoarthritis at L5-S1. It seems more accurate to consider facet joint osteoarthritis a failure of the whole joint structure, including the paraspinal musculature, rather than simply a failure of the facet joint cartilage. [Orthopedics. 2017; 40(5):e793-e800.].
Collapse
|
74
|
Rivard J, Unsleber C, Schomacher J, Erlenwein J, Petzke F, Falla D. Activation of the semispinalis cervicis and splenius capitis with cervical pulley exercises. Musculoskelet Sci Pract 2017; 30:56-63. [PMID: 28570930 DOI: 10.1016/j.msksp.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Quasi-Experimental. OBJECTIVE To assess the activation of semispinalis cervicis (d-SSC) and splenius capitis (s-SC) muscles, and the activation between the two during neck pulley and free weight exercises. BACKGROUND Altered activation of cervical extensors may occur with neck pain, suggesting that exercises should be designed to target these muscles. METHODS d-SSC and s-SC activity was recorded unilaterally with intramuscular electromyography from healthy volunteers during cervical isometric exercises: 1) extension with a pulley rope angled from incline to vertical, 2) extension with right, left and central forehead hanging weight, and 3) rotation with pulley rope angled from incline to decline. RESULTS Extension against a vertical force led to greater activation of d-SSC (P < 0.001) and s-SC (P < 0.001) compared to the inclined, declined and horizontal pulley. With each of these conditions, amplitude of muscle activity was higher for the d-SSC compared to the s-SC muscle (P < 0.0001). Extension with free weight hanging on right, left or central forehead, showed no differences across conditions, although in each condition, the d-SSC amplitude was higher than the s-SC. For cervical rotation, the declined pulley led to the greatest activation of both muscles (P < 0.05). Higher levels of activity were observed for the s-SC compared to the d-SSC (P < 0.01) for all rotation conditions. CONCLUSION A vertical resistance during an extension exercise or a declined resistance during cervical rotation, increased neck extensor activation. The results from this preliminary study provide guidance for future work on the exploration and development of low-load exercise design for patients with neck pain disorders.
Collapse
Affiliation(s)
- Jim Rivard
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA.
| | - Cindy Unsleber
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA
| | | | - Joachim Erlenwein
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Frank Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Deborah Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
75
|
Abstract
A previous special issue of JOSPT (October 2016) discussed whiplash in terms of the clinical problems and current research surrounding prevention, biomechanics of injury, emergent care, imaging advancements, recovery pathways and prognosis, pathogenesis of posttrauma pain, acute and chronic management, and new predictive clinical tools. While great strides have been made in the field of whiplash and are continuing in earnest, a key group of clinicians and academics have recognized that inconsistent outcomes in published literature hamper our ability to meaningfully synthesize research findings, leading to results of systematic reviews that provide very few concrete clinical recommendations. We are optimistic that improved outcomes for people with whiplash-associated disorder (WAD) are attainable in the near future, as interdisciplinary research efforts continue to align internationally, new mechanisms are identified and explored, and advanced statistical techniques allow complex questions to be answered in clinically meaningful ways. J Orthop Sports Phys Ther 2017;47(7):444-446. doi:10.2519/jospt.2017.0106.
Collapse
|
76
|
Abstract
Synopsis The development of persistent symptoms following whiplash injury from a motor vehicle collision is common and contributes substantially to societal and personal costs. The popular Quebec Task Force classification system of whiplash-associated disorders (WADs) was meant to function as a prognostic and intervention decision aid, but its usefulness has been questioned. Emerging evidence highlights the heterogeneity of WAD by demonstrating physical and psychological impairments that are unique to those who develop persistent symptoms. These impairments are not recognized in the Quebec Task Force classification system. The purpose of this clinical commentary is to describe an integrated model that focuses on how psychological and neurobiological factors interact with, and are influenced by, existing personal and environmental factors to contribute to the development of chronic WAD. The model has been developed through more than 20 years of work in the field, consultation with experts, in-depth synthesis of existing evidence, and new evidence from the authors' own research programs. A subtheme is that a point of convergence currently exists between the psychological, physiological, and social determinants of health literature that can further explain the complex presentation of WAD. The new model is proposed to orient future research toward more interdisciplinary efforts across nontraditional fields, including data scientists and consumers, to clarify the WAD condition. J Orthop Sports Phys Ther 2017;47(7):462-471. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7455.
Collapse
|
77
|
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.
Collapse
|
78
|
Abstract
Synopsis The majority of people with whiplash-associated disorder do not have neurological deficit or fracture and are therefore largely managed with nonsurgical interventions such as exercise, patient education, and behavioral-based interventions. To date, clinical guidelines, systematic reviews, and the results of high-quality randomized controlled trials recommend exercise and patient education as the primary interventions for people in both acute and chronic stages after injury. However, the relatively weak evidence and small effect sizes in individual trials have led authors of some systematic reviews to reach equivocal recommendations for either exercise or patient education, and led policy makers and funders to question whether the more expensive intervention (exercise) should be funded at all. Physical therapists, one of the most commonly consulted professionals treating individuals with whiplash-associated disorder, need to look beyond the evidence for insights as to what role patient education and exercise should play in the future management of whiplash. This clinical commentary therefore will review the evidence for exercise, patient education, and behavioral-based interventions for whiplash and provide clinical insight as to the future role that exercise and patient education should play in the management of this complex condition. Possible subgroups of patients who may best respond to exercise will be explored using stratification based on impairments, treatment response, and risk/prognostic factors. J Orthop Sports Phys Ther 2017;47(7):481-491. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7138.
Collapse
|
79
|
The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges. J Orthop Sports Phys Ther 2017. [PMID: 28622486 DOI: 10.2519/jospt.2017.7255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Chronic neck pain is a common condition and a primary clinical symptom of whiplash and other spinal injuries. Loading-induced neck injuries produce abnormal kinematics between the vertebrae, with the potential to injure facet joints and the afferent fibers that innervate the specific joint tissues, including the capsular ligament. Mechanoreceptive and nociceptive afferents that innervate the facet have their peripheral terminals in the capsule, cell bodies in the dorsal root ganglia, and terminal processes in the spinal cord. As such, biomechanical loading of these afferents can initiate nociceptive signaling in the peripheral and central nervous systems. Their activation depends on the local mechanical environment of the joint and encodes the neural processes that initiate pain and lead to its persistence. This commentary reviews the complex anatomical, biomechanical, and physiological consequences of facet-mediated whiplash injury and pain. The clinical presentation of facet-mediated pain is complex in its sensory and emotional components. Yet, human studies are limited in their ability to elucidate the physiological mechanisms by which abnormal facet loading leads to pain. Over the past decade, however, in vivo models of cervical facet injury that reproduce clinical pain symptoms have been developed and used to define the complicated and multifaceted electrophysiological, inflammatory, and nociceptive signaling cascades that are involved in the pathophysiology of whiplash facet pain. Integrating the whiplash-like mechanics in vivo and in vitro allows transmission of pathophysiological mechanisms across scales, with the hope of informing clinical management. Yet, despite these advances, many challenges remain. This commentary further describes and highlights such challenges. J Orthop Sports Phys Ther 2017;47(7):450-461. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7255.
Collapse
|
80
|
Uthaikhup S, Assapun J, Kothan S, Watcharasaksilp K, Elliott JM. Structural changes of the cervical muscles in elder women with cervicogenic headache. Musculoskelet Sci Pract 2017; 29:1-6. [PMID: 28259769 DOI: 10.1016/j.msksp.2017.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/30/2017] [Accepted: 02/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence suggests that cervicogenic headache is associated with increasing age. Cervical musculoskeletal impairments are common features in individuals with cervicogenic headache. There is some suggestion that the structure (size and fatty infiltration) of neck muscle may factor in or contribute to these impairments. OBJECTIVE To investigate relative cross sectional areas (rCSAs) and fatty infiltrate in the cervical muscles in elders with cervicogenic headache compared to controls. METHODS Fourteen elder women with cervicogenic headache and 14 controls participated in the study. The rCSAs and fat infiltration were measured for the rectus capitis posterior major, rectus capitis posterior minor, multifidus, semispinalis capitis, splenius capitis, longus capitis/colli, and sternocleidomastoid. RESULTS Elder women with cervicogenic headache had significantly reduced rCSAs of the rectus capitis posterior major and multifidus muscles compared to controls (p < 0.05). Larger amounts of fat infiltrates were also observed in the rectus capitis posterior major and minor and splenius capitis muscles in the cervicogenic headache group (p < 0.05). There were no changes in the size and fat infiltrate in the cervical flexor muscles (p > 0.05). CONCLUSION The study demonstrated muscle atrophy with increased fatty infiltration in regionally select muscles of the upper and segmental cervical spine in older women with cervicogenic headache. While such changes and their influence on clinical symptoms are unknown, they may have management implications. Future research investigations are required to determine whether such alterations could be modified with specific exercise and modifications to daily living to positively influence clinical symptoms.
Collapse
Affiliation(s)
- Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand.
| | - Jenjira Assapun
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suchart Kothan
- Department of Radiology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
81
|
Clinical prediction rules for prognosis and treatment prescription in neck pain: A systematic review. Musculoskelet Sci Pract 2017; 27:155-164. [PMID: 27852530 DOI: 10.1016/j.math.2016.10.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
Clinical prediction rules (CPRs) developed to identify sub-groups of people with neck pain for different prognoses (i.e. prognostic) or response to treatments (i.e. prescriptive) have been recommended as a research priority to improve health outcomes for these conditions. A systematic review was undertaken to identify prognostic and prescriptive CPRs relevant to the conservative management of adults with neck pain and to appraise stage of development, quality and readiness for clinical application. Six databases were systematically searched from inception until 4th July 2016. Two independent reviewers assessed eligibility, risk of bias (PEDro and QUIPS), methodological quality and stage of development. 9840 records were retrieved and screened for eligibility. Thirty-two studies reporting on 26 CPRs were included in this review. Methodological quality of included studies varied considerably. Most prognostic CPR development studies employed appropriate designs. However, many prescriptive CPR studies (n = 12/13) used single group designs and/or analysed controlled trials using methods that were inadequate for identifying treatment effect moderators. Most prognostic (n = 11/15) and all prescriptive (n = 11) CPRs have not progressed beyond the derivation stage of development. Four prognostic CPRs relating to acute whiplash (n = 3) or non-traumatic neck pain (n = 1) have undergone preliminary validation. No CPRs have undergone impact analysis. Most prognostic and prescriptive CPRs for neck pain are at the initial stage of development and therefore routine clinical use is not yet supported. Further validation and impact analyses of all CPRs are required before confident conclusions can be made regarding clinical utility.
Collapse
|
82
|
Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskelet Disord 2017; 18:25. [PMID: 28103921 PMCID: PMC5247810 DOI: 10.1186/s12891-016-1378-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open
Abstract
Background There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers. Method In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described. Results Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI. Conclusions We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality.
Collapse
|
83
|
Abstract
Synopsis Recovery from a whiplash injury is varied and complex. Some individuals recover quickly and fully, while others experience ongoing pain and disability. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the injury, with little improvement after this period. Identification of factors associated with poor recovery is accumulating, and since 2000 there have been at least 10 published systematic reviews on prognostic factors for whiplash-associated disorder. Poor recovery has been consistently reported to be associated with high initial neck pain intensity and neck-related disability, posttraumatic stress symptoms, pain catastrophizing, and, to a lesser extent, low self-efficacy and cold hyperalgesia. Evidence regarding factors, including compensation status, psychological factors, structural pathology, and preinjury health status, remains equivocal. Given the huge number of predictive factors and various interpretations of recovery, adapting these data for use in clinical practice is difficult. Tools such as clinical prediction rules (CPRs), by statistically quantifying relevant data, may help to predict the probability of diagnosis, prognosis, or response to treatment. Numerous CPRs have been derived for individuals with whiplash; however, to date, only 3 prognostic CPRs have undergone external validation, and none have yet undergone impact analysis, a necessary step in providing information about the rules' ability to improve clinically relevant outcomes. J Orthop Sports Phys Ther 2016;46(10):851-861. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6918.
Collapse
|
84
|
Assessment and Management of Whiplash From the Emergency and Acute Care Setting: Care, Questions, and Future Global Research Needs. J Orthop Sports Phys Ther 2016; 46:822-825. [PMID: 27690841 DOI: 10.2519/jospt.2016.0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The primary goal of this editorial is to discuss the care patients typically receive in the immediate post-motor vehicle collision setting and the questions patients typically ask with respect to their symptoms and prognosis. Commentary and guidance are provided from the perspective of an acute care physician on what we should be able to tell patients and providers going forward. J Orthop Sports Phys Ther 2016;46(10):822-825. doi:10.2519/jospt.2016.0114.
Collapse
|
85
|
Elliott JM, Dayanidhi S, Hazle C, Hoggarth MA, McPherson J, Sparks CL, Weber KA. Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash? J Orthop Sports Phys Ther 2016; 46:862-873. [PMID: 27690836 PMCID: PMC7274526 DOI: 10.2519/jospt.2016.6735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates. For many of the probable pathoanatomical lesions (eg, fracture, ligamentous rupture, disc injury), there remains a lack of available clinical tests for identifying their presence. Fractures, particularly at the craniovertebral and cervicothoracic junctions, may be radiographically occult. While high-resolution computed tomography scans can detect fractures, there remains a lack of prevalence data for fractures in this population. Conventional magnetic resonance imaging has not consistently revealed lesions in patients with acute or chronic whiplash, a "failure" that may be due to limitations in the resolution of available devices and the use of standard sequences. The technological evolution of imaging techniques and sequences eventually might provide greater resolution to reveal currently elusive anatomical lesions (or, perhaps more importantly, temporal changes in physiological responses to assumed lesions) in those patients at risk of poor recovery. Preliminary findings from 2 prospective cohort studies in 2 different countries suggest that this is so, as evidenced by changes to the structure of skeletal muscles in those who do not fully recover. In this clinical commentary, we will briefly introduce the available imaging decision rules and the current knowledge underlying the pathomechanics and pathophysiology of whiplash. We will then acknowledge known prognostic factors underlying functional recovery. Last, we will highlight emerging evidence regarding the pathobiology of muscle degeneration/regeneration, as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, functional magnetic resonance imaging, magnetization transfer imaging, spectroscopy, diffusion-weighted imaging) that may be used as noninvasive and objective complements to known prognostic factors associated with whiplash recovery, in particular, poor functional recovery. J Orthop Sports Phys Ther 2016;46(10):861-872. doi:10.2519/jospt.2016.6735.
Collapse
|
86
|
Crawford RJ, Volken T, Valentin S, Melloh M, Elliott JM. Rate of lumbar paravertebral muscle fat infiltration versus spinal degeneration in asymptomatic populations: an age-aggregated cross-sectional simulation study. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:21. [PMID: 27536737 PMCID: PMC4975884 DOI: 10.1186/s13013-016-0080-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND The spinal column including its vertebrae and disks has been well examined and extensively reported in relation to age-aggregated degeneration. In contrast, paravertebral muscles are poorly represented in describing normative degeneration. Increasing evidence points to the importance of paravertebral muscle quality in low back health, and their potential as a modifiable factor in low back pain (LBP). Studies examining normative decline of paravertebral muscles are needed to advance the field's etiological understanding. With a novel approach and based on published data, we establish and compare decline rates of imaging features for degeneration of lumbar vertebrae and disks, versus fatty infiltration in paravertebral muscles in asymptomatic adults. METHODS Our cross-sectional simulation study examined age-aggregated data from three published studies who reported on asymptomatic adults spanning 18-60 years. Prevalence rates of imaging degenerative features of the spinal column were examined via logistic regression and compared with percentage fatty infiltration in erector spinae, multifidus and psoas using synthetic data and Monte Carlo simulation with 10,000 endpoint-specific regression iterations. General linear regression models were employed to estimate marginal effects of age reported as a one-year change rate (with 95 % confidence intervals) for comparisons between all reported spinal features. RESULTS Declines in multifidus (0.24 & 0.11 %/year), erector spinae (0.13 & 0.07 %/year), and psoas (0.04 %/year) occur at similarly slow rates to disk protrusion (0.25 %/year), annular fissure (0.15 %/year), and spondylolisthesis (0.29 %/year). Multifidus showed a trend for faster decline than erector spinae, particularly in men. Of the features examined, disk signal loss declined fastest, and psoas muscle the slowest. CONCLUSIONS Degeneration of lumbar paravertebral muscles occurs slowly in asymptomatic adults, with a tendency to be most pronounced in multifidus. Rate of decline of spinal structures represents a novel variable that warrants inclusion as a known feature of the expected degenerative cascade, and to provide a basis for comparison to diseases of the spine in research and clinical practice. Concurrent examination of spinal features using advanced imaging to improve muscle analysis would be a strong addition to the field.
Collapse
Affiliation(s)
- Rebecca J Crawford
- Institute for Health Sciences, School of Health Professions, ZHAW, Zurich University of Applied Sciences, Technikumstrasse 81, CH-8401 Winterthur, Switzerland ; Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Thomas Volken
- Institute for Health Sciences, School of Health Professions, ZHAW, Zurich University of Applied Sciences, Technikumstrasse 81, CH-8401 Winterthur, Switzerland
| | - Stephanie Valentin
- Equine Clinic, University of Veterinary Medicine, Vienna, Austria ; Institute for Sport, Physical Education & Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Markus Melloh
- Institute for Health Sciences, School of Health Professions, ZHAW, Zurich University of Applied Sciences, Technikumstrasse 81, CH-8401 Winterthur, Switzerland ; Faculty of Health Sciences, Curtin University, Perth, Australia ; Centre for Medical Research, University of Western Australia, Perth, Australia
| | - James M Elliott
- Institute for Health Sciences, School of Health Professions, ZHAW, Zurich University of Applied Sciences, Technikumstrasse 81, CH-8401 Winterthur, Switzerland ; Feinberg School of Medicine, Northwestern University, Chicago, USA ; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| |
Collapse
|
87
|
Peolsson A, Peterson G, Trygg J, Nilsson D. Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders. Sci Rep 2016; 6:30415. [PMID: 27484361 PMCID: PMC4971461 DOI: 10.1038/srep30415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/01/2016] [Indexed: 11/12/2022] Open
Abstract
Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.
Collapse
Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Sweden
| | - Johan Trygg
- Computational Life Science Cluster (CLiC), Department of Chemistry, Umeå University, Sweden
| | - David Nilsson
- Computational Life Science Cluster (CLiC), Department of Chemistry, Umeå University, Sweden
| |
Collapse
|
88
|
Mhuiris ÁN, Volken T, Elliott JM, Hoggarth M, Samartzis D, Crawford RJ. Reliability of quantifying the spatial distribution of fatty infiltration in lumbar paravertebral muscles using a new segmentation method for T1-weighted MRI. BMC Musculoskelet Disord 2016; 17:234. [PMID: 27230072 PMCID: PMC4882844 DOI: 10.1186/s12891-016-1090-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/19/2016] [Indexed: 12/05/2022] Open
Abstract
Background To our knowledge, there are no methods allowing for quantification of the spatial distribution of lumbar paravertebral muscle fatty infiltration (FI) in the transverse plane. There is an increasing emphasis on muscle tissues as modifiable factors in lumbar spine health. Population datasets based on conventional T1-weighted (T1-W) magnetic resonance imaging (MRI) represent a valuable resource for examining all spinal tissues, and methods with reliability are needed. The aim of our study was to determine the reliability of a novel method quantifying lumbar paravertebral muscle fat content based on conventional T1-W MRI. Methods Axial 3-Tesla T1W MRIs from ten adult subjects (3W, 7M; mean age 52.8 ± SD 7.2 years) were randomly selected from the large prospective cross-sectional Hong Kong Population-based Disc Degeneration Cohort study examining lumbar spine degeneration. The selected sample included subjects with mixed imaging-determined disc degeneration and low back pain history. Two raters with MRI lumbar paravertebral muscle analysis experience (R1 > 250 h and R2 > 1000 h) repeat-measured the image-set a week apart. Multifidus and erector spinae (spinalis, longissimus and iliocostalis) were manually outlined together on a single-slice from the inferior vertebral end-plates of L1 to L5 using a semi-automated, quartile-defining (Q1-4 (medial to lateral) and Qmean) MatLab-based programme. Bland-Altman plots and intra-class correlation coefficients (ICC) with 95 % confidence intervals (CI) describe intra- and inter-rater reliability according to lumbar level, quartile, and side, and combined level and quartile. Results There was good intra- (ICC = 0.88; CI: 0.87–0.90) and inter-rater agreement (ICC = 0.82; CI: 0.80–0.84). Intra-rater values for Qmean (ICC; CI) were higher at L5 (0.89; 0.79–0.94) than L1 (0.61; 0.37–0.78). Higher intra-rater values for L1-5 were shown at Q1 (0.93; 0.91–0.95) than Q3 (0.83; 0.78–0.87) or Q4 (0.81; 0.76–0.85), and on the right (0.91; 0.90–0.93) than left (0.85; 0.83–0.88). Similar observations were made for inter-rater values in terms of lumbar level and quartile, with no differences between sides shown. Conclusions In our study of ten cases we demonstrate a reliable method to quantify the spatial distribution of fat content in lumbar paravertebral muscles based on T1W MRI. Understanding the geography of fat content in these muscles may offer additional insight in determining and improving spinal health. The clinical relevance and application of this method require testing across various populations to build on the early feasibility established in this study.
Collapse
Affiliation(s)
- Áine Ni Mhuiris
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland
| | - Thomas Volken
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland
| | - James M Elliott
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland.,Feinberg School of Medicine, Northwestern University, Chicago, USA.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Mark Hoggarth
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,McCormick School of Engineering, Northwestern University, Evanston, USA
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfalum, Hong Kong, SAR China
| | - Rebecca J Crawford
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland. .,Faculty of Health Professions, Curtin University, Perth, Australia.
| |
Collapse
|
89
|
Crawford RJ, Filli L, Elliott JM, Nanz D, Fischer MA, Marcon M, Ulbrich EJ. Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers. AJNR Am J Neuroradiol 2016; 37:742-8. [PMID: 26635285 DOI: 10.3174/ajnr.a4596] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Normative age-related decline in paravertebral muscle quality is important for reference to disease and risk identification in patients. We aimed to establish age- and vertebral level-dependence of paravertebral (multifidus and erector spinae) muscle volume and fat content in healthy adult volunteers. MATERIALS AND METHODS In this prospective study multifidus and erector spinae fat signal fraction and volume at lumbar levels L1-L5 were measured in 80 healthy volunteers (10 women and men per decade, 20-62 years of age) by 2-point Dixon 3T MR imaging. ANOVA with post hoc Bonferroni correction compared fat signal fraction and volume among subgroups. Pearson and Spearman analysis were used for correlations (P < .05). RESULTS Fat signal fraction was higher in women (17.8% ± 10.7%) than men (14.7% ± 7.8%; P < .001) and increased with age. Multifidus and erector spinae volume was lower in women (565.4 ± 83.8 cm(3)) than in men (811.6 ± 98.9 cm(3); P < .001) and was age-independent. No differences in fat signal fraction were shown between the right and left paravertebral muscles or among the L1, L2, and L3 lumbar levels. The fat signal fraction was highest at L5 (women, 31.9% ± 9.3%; men, 25.7% ± 8.0%; P < .001). The fat signal fraction at L4 correlated best with total lumbar fat signal fraction (women, r = 0.95; men, r = 0.92, P < .001). Total fat signal fraction was higher in the multifidus compared with erector spinae muscles at L1-L4 for both sexes (P < .001). CONCLUSIONS Lumbar paravertebral muscle fat content increases with aging, independent of volume, in healthy volunteers 20-62 years of age. Women, low lumbar levels, and the multifidus muscle are most affected. Further study examining younger and older subjects and the functional impact of fatty infiltrated paravertebral muscles are warranted.
Collapse
Affiliation(s)
- R J Crawford
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Faculty of Health Professions (R.J.C.), Curtin University, Perth, Australia
| | - L Filli
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - J M Elliott
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Feinberg School of Medicine (J.M.E.), Northwestern University, Chicago, Illinois School of Health and Rehabilitation Sciences (J.M.E.), University of Queensland, Brisbane, Australia
| | - D Nanz
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M A Fischer
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M Marcon
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland Institute of Diagnostic Radiology (M.M.), University Hospital Santa Maria della Misericordia, Udine, Italy
| | - E J Ulbrich
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| |
Collapse
|
90
|
Kurd MF, Alijanipour P, Schroeder GD, Millhouse PW, Vaccaro A. Magnetic Resonance Imaging Following Spine Trauma. JBJS Rev 2015; 3:01874474-201510000-00006. [PMID: 27490791 DOI: 10.2106/jbjs.rvw.o.00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mark F Kurd
- Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
| | | | | | | | | |
Collapse
|
91
|
Smith AC, Parrish TB, Hoggarth MA, McPherson JG, Tysseling VM, Wasielewski M, Kim HE, Hornby TG, Elliott JM. Potential associations between chronic whiplash and incomplete spinal cord injury. Spinal Cord Ser Cases 2015; 1. [PMID: 27630770 DOI: 10.1038/scsandc.2015.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN This research utilized a cross-sectional design with control group inclusion. OBJECTIVES Preliminary evidence suggests that a portion of the patient population with chronic whiplash may have sustained spinal cord damage. Our hypothesis is that in some cases of chronic whiplash-associated disorders (WAD), observed muscle weakness in the legs will be associated with local signs of a partial spinal cord injury of the cervical spine. SETTING University based laboratory in Chicago, IL, USA. METHODS Five participants with chronic WAD were compared with five gender/age/height/weight/body mass index (BMI) control participants. For a secondary investigation, the chronic WAD group was compared with five unmatched participants with motor incomplete spinal cord injury (iSCI). Spinal cord motor tract integrity was assessed using magnetization transfer imaging. Muscle fat infiltration (MFI) was quantified using fat/water separation magnetic resonance imaging. Central volitional muscle activation of the plantarflexors was assessed using a burst superimposition technique. RESULTS We found reduced spinal cord motor tract integrity, increased MFI of the neck and lower extremity muscles and significantly impaired voluntary plantarflexor muscle activation in five participants with chronic WAD. The lower extremity structural changes and volitional weakness in chronic WAD were comparable to participants with iSCI. CONCLUSION The results support the position that a subset of the chronic whiplash population may have sustained partial damage to the spinal cord. SPONSORSHIP NIH R01HD079076-01A1, NIH T32 HD057845 and the Foundation for Physical Therapy Promotion of Doctoral Studies program.
Collapse
Affiliation(s)
- Andrew C Smith
- Northwestern University Interdepartmental Neuroscience Program, Chicago, IL USA; Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Todd B Parrish
- Northwestern University Department of Radiology, Chicago, IL USA
| | - Mark A Hoggarth
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Jacob G McPherson
- Florida International University Department of Biomedical Engineering, Miami, FL USA
| | - Vicki M Tysseling
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Marie Wasielewski
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Hyosub E Kim
- Rehabilitation Institute of Chicago, Chicago, IL USA
| | | | - James M Elliott
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| |
Collapse
|