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Evans AR, Smith L, Bakhsheshian J, Anderson DB, Elliott JM, Shakir HJ, Smith ZA. Sarcopenia and the management of spinal disease in the elderly. GeroScience 2024:10.1007/s11357-024-01300-2. [PMID: 39138794 DOI: 10.1007/s11357-024-01300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.
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Affiliation(s)
- Alexander R Evans
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | | | | | - David B Anderson
- Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - James M Elliott
- Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - Hakeem J Shakir
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
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Li Q, Long X, Wang R, Niu P, Cai L, Wang L, Song Y. Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle. Front Endocrinol (Lausanne) 2024; 15:1391970. [PMID: 38962678 PMCID: PMC11220226 DOI: 10.3389/fendo.2024.1391970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To investigate the relationship between degeneration of cervical intervertebral disc and degeneration of paravertebral muscles[multifidus (MF), cervical semispinalis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL)]. Methods 82 patients with chronic neck pain were randomly selected, including 43 males and 39 females, with 50.73 0.7.51 years old. All patients were scanned by 3.0T MRI Philips Ingenia performed conventional MRI sequence scanning and fat measurement sequence mDIXON-Quant scanning of cervical. Fat infiltration (FI) and cross-sectional area (CSA) of cervical paravertebral muscle (MF, SCer, SCap and SPL) at central level of C5-6 disc were measured by Philips 3.0T MRI image post-processing workstation. According to Pfirrmann grading system, there was no grade I in the included cases. The number of grade IIr IV cases were n=16, 40, 19 and 7 respectively. CSA and FI of cervical paravertebral muscles were compared with t test or one-way ANOVA, Spearman correlation analysis was used to evaluate the correlation between age, disc degeneration, and CSA, FI of cervical paravertebral muscles, and multiple linear regression analysis was used to analyze the independent influencing factors of CSA and FI. Results CSA of cervical paravertebral muscles in male patients was significantly higher than that in female patients (all P<0.001), but there was no significant difference in FI (all P>0.05). Age was weakly correlated with CSA of MF+SCer, moderately correlated with CSA of SCap and SPL (r=-0.256, -0.355 and -0.361, P<0.05), weakly correlated with FI of SCap and SPL (r= 0.182 and 0.264, P<0.001), moderately correlated with FI of MF+SCer (r=0.408, P<0.001). There were significant differences in FI with disc degeneration (P<0.001, P=0.028 and P=0.005). Further correlation analysis showed that disc degeneration was strongly correlated with FI of MF+SCer (r=0.629, P<0.001), and moderately correlated with FI of SCap and SPL (r=0.363, P=0.001; r=0.345, P=0.002). Multiple linear regression analysis showed that sex and age were the influencing factors of CSA of SCap and SPL, sex was the independent influencing factor of CSA of MF+SCer, and disc degeneration was the independent influencing factor of FI. Conclusions Age is negatively correlated with CSA and positively correlated with FI. Disc degeneration was correlated with FI of paravertebral muscles, especially with FI of MF and SCer. Sex and age were the influencing factors of CSA, while disc degeneration was the independent influencing factor of FI.
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Affiliation(s)
- Qiujiang Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xingxia Long
- Department of Thoracic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Wang
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Pengying Niu
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lei Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Naghdi N, Elliott JM, Weber MH, Fehlings MG, Fortin M. Morphological Changes of Deep Extensor Neck Muscles in Relation to the Maximum Level of Cord Compression and Canal Compromise in Patients With Degenerative Cervical Myelopathy. Global Spine J 2024; 14:1184-1192. [PMID: 36289049 PMCID: PMC11289561 DOI: 10.1177/21925682221136492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To examine the relationship between morphological changes of the deep extensor neck muscles in patients with degenerative cervical myelopathy (DCM) and the level of maximum spinal cord compression (MSCC) and canal compromise (MCC). A secondary objective was to examine the relationship between muscle morphological changes with neck pain and functional scores related to neck pain and interference. METHODS A total of 171 patients with DCM were included. Total cross-sectional area (CSA), functional CSA (fat free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together, and cervical muscle as a group (eg, MF, SCer, semispinalis capitis, splenius capitis) were obtained from T2-weighted axial MR images at mid-disc, at the level of maximum cord compression and the level below. The relationship between the muscle parameters of interest, MSCC, MCC and functional scores including the Neck Disability Index (NDI) was assessed using multivariate linear regression models, adjusting for age, body mass index and sex. RESULTS Greater MF + Scer fatty infiltration was associated with greater MCC (P = .032) and MSCC (P = .049) at the same level. Greater asymmetry in MF + SCer CSA was also associated with greater MCC (P = .006). Similarly, greater asymmetry in FCSA and FCSA/CSA of the entire extensor muscle was associated with greater MCC (P = .011, P = .013). There was a negative association between asymmetry in FCSA MF + SCer, FCSA/CSA MF + SCer and FCSA/CSA group muscles with NDI score at the level below. CONCLUSION Greater MCC is associated with increased fatty infiltration and greater asymmetry of the deep cervical muscles in patients with DCM. A negative association between muscle asymmetry and NDI scores was also observed which has implications for clinical prediction around axial neck pain.
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Affiliation(s)
- Neda Naghdi
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - James M. Elliott
- The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
- The Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael H. Weber
- Montreal General Hospital Site, Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Michael G. Fehlings
- Department of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC, Canada
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Javanshir K, Ghafouri-Rouzbehani P, Zohrehvand A, Naeimi A, Fernández-de-las-Peñas C, Nikbakht HA, Mousavi-Khatir SR, Valera-Calero JA. Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study. J Clin Med 2024; 13:624. [PMID: 38276132 PMCID: PMC10816935 DOI: 10.3390/jcm13020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.
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Affiliation(s)
- Khodabakhsh Javanshir
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Payam Ghafouri-Rouzbehani
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Amirhossein Zohrehvand
- Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol 47176-47745, Iran;
| | - Arvin Naeimi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht 41446-66949, Iran;
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran;
| | - Seyedeh Roghayeh Mousavi-Khatir
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
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Naghdi N, Elliott JM, Weber MH, Fehlings MG, Fortin M. Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes. Front Neurol 2023; 14:1209475. [PMID: 37745653 PMCID: PMC10512835 DOI: 10.3389/fneur.2023.1209475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives This study aimed to examine whether preoperative cervical muscle size, composition, and asymmetry from magnetic resonance imaging (MRI) can predict post-operative outcomes in patients with degenerative cervical myelopathy (DCM). Methods A total of 171 patients with DCM were included. Relative total cross-sectional area (RCSA), functional CSA (fat-free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together (MF + SCer), and cervical muscle as a group (MF, SCer, semispinalis capitis, and splenius capitis) were obtained from T2-weighted axial MR images at the mid-disk, at the level of maximum cord compression and the level below. Univariate and multivariate linear regression analyses were used to assess the relationship between baseline cervical muscle measurements of interest with the modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 health survey at 6-month and 12-month post-surgery. Results Lower RCSA of MF + SCer, less CSA MF + SCer asymmetry and greater FCSA/CSA for the cervical muscle group (e.g., less fatty infiltration), and younger age were significant predictors of higher mJOA scores (e.g., less disability) at 6-month and 12-month post-surgery (all p < 0.05). Greater CSA asymmetry in MF + SCer and lower FCSA/CSA (e.g., more fatty infiltration) for the cervical muscle group were significant predictors of higher Nurick scores (e.g., more disability) at 6-month and 12-month post-surgery (all p < 0.05). Lower FCSA MF + Scer asymmetry, lower FCSA/CSA asymmetry of the muscle group, and greater RCSA MF + SCer were significant predictors of higher NDI scores at 6-month and 12-month post-surgery. Finally, greater FCSA/CSA asymmetry of the MF + SCer, greater FCSA asymmetry of the muscle group, greater RCSA of the muscle group, and greater CSA asymmetry of MF + SCer were significant predictors of lower post-operative SF-36 scores at 6- and 12-month post-surgery. Conclusion Our result suggested that cervical paraspinal muscle morphology, specifically greater asymmetry, and fatty infiltration may be important predictors of functional recovery and post-surgical outcomes in patients with DCM.
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Affiliation(s)
- Neda Naghdi
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - James M. Elliott
- The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
- The Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael H. Weber
- Montreal General Hospital Site, Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Michael G. Fehlings
- Department of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Readaptation (CRIR), Montreal, QC, Canada
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Li Z, Liang Q, Li H, Lin X, Meng J, Yang D, Li C, Liang Y, Yang Y, Lin Y, Liang Z. Fatty infiltration of the cervical multifidus musculature and its clinical correlation to cervical spondylosis. BMC Musculoskelet Disord 2023; 24:613. [PMID: 37501110 PMCID: PMC10373323 DOI: 10.1186/s12891-023-06595-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/01/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Fat infiltration (FI) of the deep neck extensor muscles has been shown to be associated with poor outcomes in cervical injury, mechanical neck pain, and axial symptoms after cervical spine surgery. However, information is scarce on the severity of FI in cervical extensors associated with different clinical syndromes in patients with cervical spondylosis. OBJECTIVE To investigate the relationship between the severity of FI in the cervical multifidus musculature and its clinical correlates in the syndromes and sagittal alignment of patients with cervical spondylosis. METHODS This study was conducted as a retrospective study of twenty-eight healthy volunteers (HV) together with sixty-six patients who underwent cervical radiculopathy (CR), degenerative myelopathy (DM), and axial joint pain (AJP) from January 2020 to March 2022. MRI was used to measure the fat cross-sectional area (FCSA), functional muscle cross-sectional area (FMCSA), total muscle cross-sectional area (TMCSA), FI ratio of the cervical multifidus musculature at each cervical level from the C3 to C6 segments and the cervical lordosis angle in the included subjects. RESULTS The difference in the FCSA and FI ratio in patient groups with cervical spondylosis was significantly greater than that of the HV group (P < 0.05), and the Cobb angle of the DM group, AJP group and HV group was significantly greater than that of the CR group (P < 0.05). The FI ratio comparison showed no significant difference by sex, and the comparison of FCSA, FMCSA, TMCSA and FI ratio showed no significant difference by age range from 35 to 69 in the included subjects. The FCSA and TMCSA in patients with cervical spondylosis were positively related to the Cobb angle (rs= 0.336, P = 0.006, rs =0.319, P = 0.009, respectively), and the FI ratio was inversely correlated with the Cobb angle (rs= -0.285, P = 0.020) and positively correlated with age (rs =0.261, P = 0.034). In the HV group, FMCSA was inversely correlated with age (rs= -0.400, P = 0.035), while the FI ratio had a positive correlation with age (rs= -0.423, P = 0.025). CONCLUSION Compared with healthy subjects, a more severe degree of FI in the multifidus musculature and sagittal imbalance were found in patients with cervical spondylosis. These two imaging features are considered to be important concomitant phenomena of cervical spondylosis, and the more severe FI is, the worse the sagittal imbalance. However, each syndrome had no obvious difference in FI in the multifidus musculature.
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Affiliation(s)
- Zhifei Li
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi University of Chinese medicine, Nanning, 530023, Guangxi, China
| | - Qinqiu Liang
- Guangxi University of Chinese medicine, Nanning, 530001, Guangxi, China
| | - He Li
- Department of Spine Manipulation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | | | - Jiwen Meng
- Guangxi University of Chinese medicine, Nanning, 530001, Guangxi, China
| | - Daishui Yang
- Department of Orthopaedic, Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chengwei Li
- Guangxi University of Chinese medicine, Nanning, 530001, Guangxi, China
| | - Yuanyao Liang
- Guangxi University of Chinese medicine, Nanning, 530001, Guangxi, China
| | - Yin Yang
- Guangxi University of Chinese medicine, Nanning, 530001, Guangxi, China
| | - Yuanfang Lin
- Department of Spine Manipulation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518033, Guangdong, China.
| | - Ziyang Liang
- Department of Spine Manipulation, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518033, Guangdong, China.
- Department of Orthopaedic, Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Niu Y, Lv Q, Gong C, Duan D, Zhou Z, Wu J. Predictive Effect of Cervical Sagittal Parameters and Corresponding Segmental Paravertebral Muscle Degeneration on the Occurrence of Cervical Kyphosis Following Cervical Laminoplasty. World Neurosurg 2023; 175:e723-e729. [PMID: 37031734 DOI: 10.1016/j.wneu.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Cervical sagittal parameters and paravertebral muscle degeneration are important factors for the occurrence of cervical spondylotic myelopathy. However, the relationship between the 2 risk factors and cervical kyphosis following cervical laminoplasty remains unknown. METHODS A total of 130 patients undergoing cervical laminoplasty were enrolled from July 2018 to July 2020 and were followed up for at least 24 months. Clinical recovery was recorded, including the Japanese Orthopedic Association, neck disability index and visual analog scale scores. Radiographic sagittal parameters were measured on cervical lateral radiographs: T1 slope (T1S), C2-C7 Cobb lordotic angle (CLA), C2-C7 sagittal vertical axis, O-C2 angle, and T1S-CLA. The magnetic resonance imaging (MRI) parameters of the paraspinal muscles were also measured, including cross-sectional area and fat infiltration (FI). The patients were divided into a kyphosis group and a lordosis group based on the last follow-up results of CLA. Multivariate logistic analysis was performed to analyze risk factors for kyphosis following laminoplasty. RESULTS Thirty-two patients were assigned to the kyphosis group and 98 were assigned to the lordosis group. Patient baseline and surgical information in the 2 groups showed no statistically significant difference. In the comparison of clinical recovery, patients with kyphosis showed a lower Japanese Orthopedic Association recovery rate than the lordosis group. For the radiographic parameters and muscle condition comparison, CLA, T1S-CLA, and FI were the most significant parameters. The logistic regression revealed that T1S-CLA and FI were the most important variables that predicted kyphosis. CONCLUSIONS We concluded that FI remarkably differed in the paraspinal muscles in the 2 groups. Multivariate logistic regression demonstrated that T1S-CLA and FI significantly influenced the process of kyphosis after cervical laminoplasty.
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Affiliation(s)
- Yahui Niu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Qingqing Lv
- Nursing School of Anhui Medical University, Anhui Province, China
| | - Chen Gong
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Duanqiang Duan
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Zhihua Zhou
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Jianming Wu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China.
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Varol U, Navarro-Santana MJ, Gómez-Sánchez S, Plaza-Manzano G, Sánchez-Jiménez E, Valera-Calero JA. Inter-Examiner Disagreement for Assessing Cervical Multifidus Ultrasound Metrics Is Associated with Body Composition Features. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031213. [PMID: 36772252 PMCID: PMC9921918 DOI: 10.3390/s23031213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 05/28/2023]
Abstract
Ultrasound imaging (US) is a biosensing technique that is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics, such as muscle morphology and quality. Since all biosensors need to be tested in order to demonstrate their reliability, accuracy, sensitivity, and specificity, identifying factors that affect their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are associated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the L5 level were acquired and analyzed in 47 healthy volunteers by two examiners (one experienced and one novice). The cross-sectional area, muscle perimeter, and mean echo intensity were calculated bilaterally. A correlation analysis and a multivariate linear regression model were used for assessing the inter-examiner differences with respect to body composition metrics. The results demonstrated good-to-excellent reliability estimates for the cross-sectional area, muscle perimeter, aspect ratio, roundness, circularity, and mean brightness metrics (all ICC > 0.85). However, solidity showed unacceptable reliability (ICC < 0.7). Age, height, total lean mass, trunk lean mass, and water volume were associated with inter-examiner disagreement on mean echo intensity. Cross-sectional area, perimeter, and roundness measurement errors were associated with lean mass and water volume.
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Affiliation(s)
- Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 29222 Alcorcón, Spain
| | | | - Sonia Gómez-Sánchez
- Faculty of Health, Universidad Católica de Ávila, C/Canteros, s/n, 05005 Ávila, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Elena Sánchez-Jiménez
- Faculty of Health, Universidad Católica de Ávila, C/Canteros, s/n, 05005 Ávila, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Association Between the Cervical Extensor Musculature and the Demographic Features, Symptoms, and Sagittal Balance in Patients with Multilevel Cervical Spondylotic Myelopathy. World Neurosurg 2023; 169:e40-e50. [PMID: 36216245 DOI: 10.1016/j.wneu.2022.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To obtain the quantitative measurements of the muscle morphology of cervical extensors in patients with multilevel cervical spondylotic myelopathy, and determine whether the morphological parameter of each muscle correlates with the patients' demographic features, symptoms, and cervical sagittal balance. METHODS We retrospectively evaluated 100 hospitalized patients scheduled to undergo surgery for multilevel cervical spondylotic myelopathy. Demographic data, including age, sex, and body mass index, were recorded, and symptoms were evaluated using the visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association scale scores. The cross-sectional area (CSA) of the multifidus, semispinalis capitis, semispinalis cervicis, splenius capitis and splenius cervicis were measured on magnetic resonance imaging. The CSA of the total extensor muscles, deep extensor muscles (DEM, consisting of multifidus and semispinalis capitis), and superficial extensor muscles (consisting of semispinalis cervicis, splenius capitis and splenius cervicis) were calculated. The adjusted CSA (aCSA) was calculated as the CSA of the muscle/CSA of the corresponding vertebral body. The fat infiltration ratio (FIR) of the posterior extensor muscles was assessed using a pseudocoloring technique. Sagittal parameters, including cervical lordosis (CL), C2-7 cervical sagittal vertical axis (SVA), T1-slope, mismatch between T1-slope and CL (T1S-CL), and range of motion, were measured. The measured parameters were compared between the males and the females, between the patients with higher muscle aCSA and the patients with lower muscle aCSA, and between the patients with and without sagittal balance. A Pearson correlation analysis was conducted to determine the correlations between the paraspinal muscle measurements, and the clinical and radiographic parameters. RESULTS There were 67 males and 33 females in this study, and the mean age was 59.22 ± 9.54 years. Compared with females, male patients showed higher CSA and aCSA of extensor muscles. Patients with lower muscle aCSA were significantly older and had worse NDI scores, with significantly greater C2-7 SVA and T1S-CL. Patients with sagittal imbalance showed significantly lower aCSA of total extensor muscles and DEM, as well as a significantly higher FIR. Age was significantly correlated with the aCSA of each measured muscle and the FIR. The aCSA of the DEM was correlated with the NDI score, the visual analog scale score, the SVA, the T1-slope, and the T1S-CL. CONCLUSIONS In patients with multilevel CSM, age and sex were demographic factors that were highly correlated with muscle morphology changes. Extensor muscles, especially DEM, play important roles in maintaining cervical sagittal balance and are associated with the severity of neck symptoms.
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He J, Wu T, Ding C, Wang B, Hong Y, Liu H. The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery. Front Endocrinol (Lausanne) 2023; 14:1128810. [PMID: 36843584 PMCID: PMC9946973 DOI: 10.3389/fendo.2023.1128810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The cervical paraspinal muscle (CPM) has an essential role in positioning, stabilizing and directing the cervical spine. However, information is lacking regarding the influence of CPM on outcomes following anterior cervical surgery. This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes in patients undergoing hybrid surgery (HS) and analyze the relationship between FI and cross-sectional area (CSA) of CPM. METHODS A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level HS. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons. RESULTS Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p = 0.053). No statistically significant differences were presented among the three groups regarding pre- and postoperative clinical evaluation scores. The cervical lordosis was significantly higher in the normal group before surgery (p = 0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p = 0.046). The function spine unit angle and disc angle of arthroplasty levels were significantly lower in the severe group than the normal group at follow-ups. Moreover, after correction according to vertebral body area, no statistically significant relationship existed between CSA ratio and FI grade. CONCLUSION CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and postoperative sagittal balance disorder, particularly in C2-7 SVA and segmental alignment of arthroplasty level. Meanwhile, FI of CPM appears to have no impact on clinical outcomes and reveals small correlations to CSA.
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12
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Doi T, Ohtomo N, Oguchi F, Tozawa K, Nakarai H, Nakajima K, Sakamoto R, Okamoto N, Nakamoto H, Kato S, Taniguchi Y, Matsubayashi Y, Oka H, Matsudaira K, Tanaka S, Oshima Y. Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2023; 13:8-16. [PMID: 33504203 PMCID: PMC9837499 DOI: 10.1177/2192568221989655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. RESULTS 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae (ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL (ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. CONCLUSIONS Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.
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Affiliation(s)
- Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Fumihiko Oguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Naoki Okamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Hiroyuki Oka
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan,Yasushi Oshima, Department of Orthopaedic
Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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13
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Snodgrass SJ, Stanwell P, Weber KA, Shepherd S, Kennedy O, Thompson HJ, Elliott JM. Greater muscle volume and muscle fat infiltrate in the deep cervical spine extensor muscles (multifidus with semispinalis cervicis) in individuals with chronic idiopathic neck pain compared to age and sex-matched asymptomatic controls: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:973. [PMID: 36357864 PMCID: PMC9647973 DOI: 10.1186/s12891-022-05924-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Muscle size and composition (muscle volume and muscle fat infiltrate [MFI]) may provide insight into possible mechanisms underpinning chronic idiopathic neck pain, a common condition with no definitive underlying pathology. In individuals with chronic idiopathic neck pain > 3 months and age- and sex-matched asymptomatic controls, muscle volumes of levator scapulae, multifidus including semispinalis cervicis (MFSS), semispinalis capitis, splenius capitis including splenius cervicis (SCSC), sternocleidomastoid and longus colli from C3 through T1 were quantified from magnetic resonance imaging. Between-group differences were determined using linear mixed models, accounting for side (left or right), muscle, spinal level, sex, age, and body mass index (BMI). Individuals with pain had greater muscle volume (mean difference 76.8mm3; 95% CI 26.6-127.0; p = .003) and MFI (2.3%; 0.2-4.5; p = .034) of the MFSS compared to matched controls with no differences in relative volume, accounting for factors associated with the outcomes: muscle, spinal level, side (left had smaller volume, relative volume and MFI than right), sex (females had less volume and relative volume than males), age (older age associated with less relative volume and greater MFI), and BMI (higher BMI associated with greater muscle volume and MFI). Greater MFI in individuals with chronic idiopathic neck pain suggests a possible underlying mechanism contributing to neck pain. Perspective: These findings suggest MFI in the MFSS may be radiologic sign, potentially identifying patients with a less favourable prognosis. Future studies are needed to confirm this finding and determine if MFI is a contributor to the development or persistence of neck pain, or consequence of neck pain.
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Affiliation(s)
- Suzanne J Snodgrass
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, Australia
| | - Peter Stanwell
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, Australia
| | - Kenneth A. Weber
- grid.168010.e0000000419368956Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - Samala Shepherd
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - Olivia Kennedy
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - Hannah J Thompson
- grid.266842.c0000 0000 8831 109XSchool of Health Sciences, The University of Newcastle, University Drive, Callaghan, Australia
| | - James M Elliott
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Medicine and Health & The Northern Sydney Local Health District - The Kolling Institute, Level 13, NSW St Leonards, Australia ,grid.16753.360000 0001 2299 3507Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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14
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Valera-Calero JA, Navarro-Santana MJ, Plaza-Manzano G, Fernández-de-las-Peñas C, Ortega-Santiago R. Identifying Demographic, Clinical, Muscular and Histological Factors Associated with Ultrasound Cervical Multifidus Measurement Errors in a Chronic Neck Pain Population. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22218344. [PMID: 36366042 PMCID: PMC9653930 DOI: 10.3390/s22218344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/01/2023]
Abstract
Ultrasound imaging (US) is a widely used imaging tool in physiotherapy for assessing muscle morphology and quality, among other purposes, such as ensuring the patients’ safety during invasive procedures or providing visual feedback during motor control exercises. Identifying factors associated with measurement errors is essential to target avoid bias in high-risk of bias populations. Therefore, this study aimed to assess whether demographic, clinical, muscular and histological factors are associated with ultrasound measurement errors in patients with idiopathic chronic neck pain. B-mode images were acquired and analyzed in 126 patients with chronic neck pain by two experienced examiners. Cross-sectional area, muscle perimeter, mean echo intensity and percentage of fatty infiltration were analyzed. The interexaminer agreement was assessed by calculating the absolute error, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC). A Pearson’s correlation matrix including all variables was calculated to conduct a multivariate linear stepwise regression model for estimating the explained variance for each measurement error. Results demonstrated excellent reliability (ICC = 0.965) for assessing the cross-sectional area, and good reliability for assessing the muscle perimeter, mean echo intensity and intramuscular infiltrates estimation (ICC = 0.898, 0.882 and 0.758, respectively). Although clinical variables were not associated with measurement errors (p > 0.05), multiple correlations were found between demographic and cervical multifidus characteristics with measurement errors.
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Affiliation(s)
- Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | | | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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Multifidus Sarcopenia Is Associated With Worse Patient-reported Outcomes Following Posterior Cervical Decompression and Fusion. Spine (Phila Pa 1976) 2022; 47:1426-1434. [PMID: 35797647 DOI: 10.1097/brs.0000000000004386] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/21/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following posterior cervical decompression and fusion (PCDF). SUMMARY OF BACKGROUND DATA While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following PCDF has not been investigated. MATERIALS AND METHODS We performed a retrospective review of patients undergoing PCDF from C2 to T2 at a single institution between the years 2017 and 2020. Two independent reviewers who were blinded to the clinical outcome scores utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral multifidus muscles at the C5-C6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups. RESULTS We identified 99 patients for inclusion in this study, including 28 patients with mild sarcopenia, 45 patients with moderate sarcopenia, and 26 patients with severe sarcopenia. There was no difference in any preoperative PROM between the subgroups. Mean postoperative Neck Disability Index scores were lower in the mild and moderate sarcopenia subgroups (12.8 and 13.4, respectively) than in the severe sarcopenia subgroup (21.0, P <0.001). A higher percentage of patients with severe multifidus sarcopenia reported postoperative worsening of their Neck Disability Index (10 patients, 38.5%; P =0.003), Visual Analog Scale Neck scores (7 patients, 26.9%; P =0.02), Patient-Reported Outcome Measurement Information System Physical Component Scores (10 patients, 38.5%; P =0.02), and Patient-Reported Outcome Measurement Information System Mental Component Scores (14 patients, 53.8%; P =0.02). CONCLUSION Patients with more severe paraspinal sarcopenia demonstrate less improvement in neck disability and physical function postoperatively and are substantially more likely to report worsening PROMs postoperatively. LEVEL OF EVIDENCE 3.
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16
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Grondin F, Freppel S, Jull G, Gérard T, Caderby T, Peyrot N. Fat Infiltration of Multifidus Muscle Is Correlated with Neck Disability in Patients with Non-Specific Chronic Neck Pain. J Clin Med 2022; 11:jcm11195522. [PMID: 36233390 PMCID: PMC9571215 DOI: 10.3390/jcm11195522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic non-specific neck pain (CINP) is common, but the etiology remains unclear. This study aimed to examine the relationship between cervical muscle composition (cervical multifidus and longus capitis/longus colli), morphometry, range of movement, muscle function, and disability severity (Neck Disability Index) in patients with CINP. Methods: From September 2020 to July 2021, subjects underwent cervical MRI and clinical tests (cervical range of motion, cranio-cervical flexion test, neck flexor, and extensor muscle endurance). MRI analysis comprised muscle cross-sectional area, volume, and fat infiltration of multifidus and longus colli between C4 and C7 levels. Results: Twenty-five participants were included. Multiple linear regression analysis indicated that NDI was positively correlated with the volume percentage of fat infiltration of the multifidus (B = 0.496), negatively correlated with fat-free muscle volume of the multifidus normalized by subject height (B = −0.230), and accounted for 32% of the variance. There was no relationship between neck disability and longus capitis/longus colli morphology. We also found no relationship between neck disability scores, neck flexor or extensor muscle endurance, or the outcome motor control test of craniocervical flexion (p > 0.05). Conclusions: Neck disability was moderately correlated with the percentage of fat volume in the multifidus muscle and fat-free volume of the multifidus. There was no relationship between NDI scores and muscle function test outcomes or any fat or volume measures pertaining to the longus colli muscle.
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Affiliation(s)
- Francis Grondin
- Laboratory IRISSE, EA4075, Faculty of Human and Environment Sciences, University of La Réunion, 97430 Le Tampon, France
- Neurosurgey Department, University Hospital of La Réunion, 97410 Saint-Pierre, France
- Correspondence: ; Tel.: +262-69-310-1725
| | - Sébastien Freppel
- Neurosurgey Department, University Hospital of La Réunion, 97410 Saint-Pierre, France
| | - Gwendolen Jull
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
| | - Thomas Gérard
- Institute of Health Engineering, University of Picardie Jules Verne, 80000 Amiens, France
| | - Teddy Caderby
- Laboratory IRISSE, EA4075, Faculty of Human and Environment Sciences, University of La Réunion, 97430 Le Tampon, France
| | - Nicolas Peyrot
- Laboratory IRISSE, EA4075, Faculty of Human and Environment Sciences, University of La Réunion, 97430 Le Tampon, France
- Laboratory Movement Interactions Performance, MIP UR4334, Le Mans University, 72000 Le Mans, France
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The relationship between preoperative cervical sagittal balance and clinical outcome of acute traumatic central cord syndrome. World Neurosurg 2022; 162:e468-e474. [DOI: 10.1016/j.wneu.2022.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
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18
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Huang Z, Bai Z, Yan J, Zhang Y, Li S, Yuan L, Huang D, Ye W. Association between muscle morphology changes, cervical spine degeneration and clinical features in patients with chronic nonspecific neck pain: a magnetic resonance imaging analysis. World Neurosurg 2021; 159:e273-e284. [PMID: 34929370 DOI: 10.1016/j.wneu.2021.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The primary objective of the present study was to investigate the correlations among cervical paraspinal muscle morphology changes (fatty infiltration (FI) and muscle atrophy), cervical degeneration and clinical features in patients with chronic nonspecific neck pain (CNSNP). METHODS The magnetic resonance imaging (MRI) data of 55 consecutive patients (average age 35.80) with CNSNP were analyzed in this cross-sectional study. Muscle morphology changes in seven groups of paraspinal muscles, indicated by the adjusted cross-sectional area (aCSA) and FI ratio (FI%), were measured from C3/4 to C6/7. The correlations of these changes with disc degeneration, cervical balance (C2-7 angle and cervical alignment) and clinical features (severity of neck pain and related disability and the frequency of acute neck pain (ANP) recurrence) were evaluated. RESULTS Significant correlations between FI% and aCSA and the grade of disc degeneration were observed in specific muscle groups at each level (p<0.05). Morphological changes in the deep extensors and superficial paraspinal muscles were significantly associated with cervical balance parameters (p<0.05). The FI% showed a significant positive correlation, while aCSA showed a significant negative correlation with the severity of neck pain and related disability (p<0.05). Correlations between morphological changes and the frequency of ANP recurrence were also present for some muscles (p<0.05). CONCLUSION Correlations among muscle morphology changes, cervical degeneration and clinical features were established for patients with CNSNP, and muscle volume changes and FI might affect CNSNP in diverse manners through different paraspinal muscle groups. These results implicated the complex contribution of muscle morphological changes to cervical degeneration and the clinical course of CNSNP.
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Affiliation(s)
- Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Bai
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiansen Yan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangyang Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuangxing Li
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Yuan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongsheng Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther 2021; 30:139-153. [PMID: 34821212 DOI: 10.1080/10669817.2021.2000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cervical disc degeneration (CDD) is a progressive, age-related occurrence that is frequently associated with neck pain and radiculopathy. Consistent with the majority of published clinical practice guidelines (CPG) for neck pain, the 2017 American Physical Therapy Association Neck Pain CPG recommends cervical manipulation as an intervention to address acute, subacute, and chronic symptoms in the 'Neck Pain With Mobility Deficits' category as well for individuals with 'Chronic Neck Pain With Radiating Pain'. While CPGs are evidence-informed statements intended to help optimize care while considering the relative risks and benefits, these guidelines generally do not discuss the mechanical consequences of underlying cervical pathology nor do they recommend specific manipulation techniques, with selection left to the practitioner's discretion. From a biomechanical perspective, disc degeneration represents the loss of structural integrity/failure of the intervertebral disc. The sequelae of CDD include posterior neck pain, segmental hypermobility/instability, radicular symptoms, myelopathic disturbance, and potential vascular compromise. In this narrative review, we consider the mechanical, neurological, and vascular consequences of CDD, including information on the anatomy of the cervical disc and the mechanics of discogenic instability, the anatomic and mechanical basis of radiculitis, radiculopathy, changes to the intervertebral foramen, the importance of Modic changes, and the effect of spondylotic hypertrophy on the central spinal canal, spinal cord, and vertebral artery. The pathoanatomical and biomechanical consequences of CDD are discussed, along with suggestions which may enhance patient safety.
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Affiliation(s)
- Brian T Swanson
- Department of Rehabilitation Sciences University of Hartford, West Hartford, CT, USA
| | - Douglas Creighton
- Human Movement Science Department Oakland University, Rochester, MI, USA
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20
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Weber KA, Abbott R, Bojilov V, Smith AC, Wasielewski M, Hastie TJ, Parrish TB, Mackey S, Elliott JM. Multi-muscle deep learning segmentation to automate the quantification of muscle fat infiltration in cervical spine conditions. Sci Rep 2021; 11:16567. [PMID: 34400672 PMCID: PMC8368246 DOI: 10.1038/s41598-021-95972-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
Muscle fat infiltration (MFI) has been widely reported across cervical spine disorders. The quantification of MFI requires time-consuming and rater-dependent manual segmentation techniques. A convolutional neural network (CNN) model was trained to segment seven cervical spine muscle groups (left and right muscles segmented separately, 14 muscles total) from Dixon MRI scans (n = 17, 17 scans < 2 weeks post motor vehicle collision (MVC), and 17 scans 12 months post MVC). The CNN MFI measures demonstrated high test reliability and accuracy in an independent testing dataset (n = 18, 9 scans < 2 weeks post MVC, and 9 scans 12 months post MVC). Using the CNN in 84 participants with scans < 2 weeks post MVC (61 females, 23 males, age = 34.2 ± 10.7 years) differences in MFI between the muscle groups and relationships between MFI and sex, age, and body mass index (BMI) were explored. Averaging across all muscles, females had significantly higher MFI than males (p = 0.026). The deep cervical muscles demonstrated significantly greater MFI than the more superficial muscles (p < 0.001), and only MFI within the deep cervical muscles was moderately correlated to age (r > 0.300, p ≤ 0.001). CNN's allow for the accurate and rapid, quantitative assessment of the composition of the architecturally complex muscles traversing the cervical spine. Acknowledging the wider reports of MFI in cervical spine disorders and the time required to manually segment the individual muscles, this CNN may have diagnostic, prognostic, and predictive value in disorders of the cervical spine.
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Affiliation(s)
- Kenneth A Weber
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vivie Bojilov
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrew C Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Marie Wasielewski
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Trevor J Hastie
- Statistics Department, Stanford University, Palo Alto, CA, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - James M Elliott
- Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia.,The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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21
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Siasios I, Samara E, Fotiadou A, Tsoleka K, Vadikolias K, Mantatzis M, Birbilis T. The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies. J Clin Med Res 2021; 13:367-376. [PMID: 34394779 PMCID: PMC8336945 DOI: 10.14740/jocmr4551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient’s functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient’s postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expression. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, General Hospital of Papageorgiou, Thessaloniki, Greece.,Department of Neurosurgery, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Ethymia Samara
- Department of Neurology, General Hospital of Papageorgiou, Thessaloniki, Greece
| | - Aggeliki Fotiadou
- Department of Neurology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Kalliopi Tsoleka
- Department of Neurosurgery, General Hospital of Papageorgiou, Thessaloniki, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Michael Mantatzis
- Department of Radiology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Theodosis Birbilis
- Department of Neurosurgery, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
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22
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Paliwal M, Weber KA, Smith AC, Elliott JM, Muhammad F, Dahdaleh NS, Bodurka J, Dhaher Y, Parrish TB, Mackey S, Smith ZA. Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model. PLoS One 2021; 16:e0253863. [PMID: 34170961 PMCID: PMC8232539 DOI: 10.1371/journal.pone.0253863] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.
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Affiliation(s)
- Monica Paliwal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Kenneth A. Weber
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Physical Therapy Program, Aurora, Colorado, United States of America
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, St. Leonards, New South Wales, Australia
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Todd B. Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sean Mackey
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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23
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Pinter ZW, Wagner S, Fredericks D, Xiong A, Helgeson M, Currier B, Freedman BA, Kepler C, Elder BD, Bydon M, Nassr A, Sebastian AS. Cervical Paraspinal Muscle Fatty Degeneration Is Not Associated with Muscle Cross-sectional Area: Qualitative Assessment Is Preferable for Cervical Sarcopenia. Clin Orthop Relat Res 2021; 479:726-732. [PMID: 33416225 PMCID: PMC8083838 DOI: 10.1097/corr.0000000000001621] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sarcopenia, defined as decreased skeletal mass, is an independent marker of frailty that is not accounted for by other risk-stratification methods. Recent studies have demonstrated a clear association between paraspinal sarcopenia and worse patient-reported outcomes and complications after spine surgery. Currently, sarcopenia is characterized according to either a quantitative assessment of the paraspinal cross-sectional area or a qualitative analysis of paraspinal fatty infiltration on MRI. No studies have investigated whether the cervical paraspinal cross-sectional area correlates with fatty infiltration of the cervical paraspinal muscles on advanced imaging. QUESTION/PURPOSE Do patients undergoing anterior cervical discectomy and fusion (ACDF) with increasing paraspinal fatty degeneration on advanced imaging also demonstrate decreased cervical paraspinal cross-sectional area? METHODS Between 2011 and 2017, 98 patients were prospectively enrolled in a database of patients undergoing one- to three-level ACDF for degenerative conditions at a single institution. To be eligible for this prospective study, patients were required to undergo an MRI before surgery, be older than 18 years, and have no previous history of cervical spine surgery. Two independent reviewers, both surgeons not involved in the patients' care and who were blinded to the clinical outcomes, retrospectively assessed the paraspinal cross-sectional area and Goutallier classification of the right-sided paraspinal muscle complex. We then compared the patients' Goutallier grades with their paraspinal cross-sectional area measurements. We identified 98 patients for inclusion. Using the Fuchs modification of the Goutallier classification, we classified the fatty degeneration of 41 patients as normal (Goutallier Grades 0 to 1), that of 47 patients as moderate (Grade 2), and that of 10 patients as severe (Grades 3 to 4). We used ANOVA to compare all means between groups. RESULTS There was no difference in the mean paraspinal cross-sectional area of the obliquus capitus inferior (normal 295 ± 81 mm2; moderate 317 ± 104 mm2; severe 300 ± 79 mm2; p = 0.51), multifidus (normal 146 ± 59 mm2; moderate 170 ± 70 mm2; severe 192 ± 107 mm2; p = 0.11), or sternocleidomastoid (normal 483 ± 150 mm2; moderate 468 ± 149 mm2; severe 458 ± 183 mm2; p = 0.85) among patients with mild, moderate, and severe fatty infiltration based on Goutallier grading. There was a slightly greater longus colli cross-sectional area in the moderate and severe fatty infiltration groups (74 ± 22 mm2 and 66 ± 18 mm2, respectively) than in the normal group (63 ± 15 mm2; p = 0.03). CONCLUSION Because our study demonstrates minimal association between paraspinal cross-sectional area and fatty infiltration of the cervical paraspinals, we recommend that physicians use the proven qualitative assessment of paraspinal fatty infiltration during preoperative evaluation of patients who are candidates for ACDF. Future studies investigating the relationship between cervical paraspinal cross-sectional area and patient-reported outcomes after ACDF are necessary to lend greater strength to this recommendation. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Zachariah W Pinter
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott Wagner
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Donald Fredericks
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley Xiong
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Melvin Helgeson
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bradford Currier
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brett A Freedman
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christopher Kepler
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Benjamin D Elder
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Nassr
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Arjun S Sebastian
- Z. W. Pinter, A. Xiong, B. Currier, B. A. Freedman, A. Nassr, A. S. Sebastian, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- S. Wagner, D. Fredericks, M. Helgeson, Walter Reed National Military Medical Center, Bethesda, MD, USA
- C. Kepler, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- B. D. Elder, M. Bydon, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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24
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Burian E, Franz D, Greve T, Dieckmeyer M, Holzapfel C, Drabsch T, Sollmann N, Probst M, Kirschke JS, Rummeny EJ, Zimmer C, Hauner H, Karampinos DC, Baum T. Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI. Eur J Radiol 2020; 125:108904. [PMID: 32088656 DOI: 10.1016/j.ejrad.2020.108904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/06/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To understand fat distribution patterns and ectopic fat deposition in healthy adults and to provide normative data, encompassing the borders of physiological regional muscle composition. For this purpose chemical shift encoding-based water-fat Magnetic Resonance Imaging (MRI) was used for proton density fat fraction (PDFF) calculations. MATERIAL AND METHODS 91 volunteers were enrolled (male: n = 28, age = 36.6 ± 11.4 years; female: n = 63, age = 38.5 ± 15.1 years). PDFF values combined for the multifidus, semispinalis and spinalis cervicis muscles at the level of the 3rd cervical vertebral body (C3), the 5th cervical vertebral body (C5) and the first thoracic vertebral body (Th1) were extracted. RESULTS The paraspinal musculature at C3 (14.8 ± 10.1 % vs. 19.2 ± 11.0 %; p = 0.029) and Th1 (13.8 ± 7.0 % vs 17.7 ± 7.4 %; p = 0.011) showed significantly lower PDFF values in men compared to women. Partial correlation testing with BMI as control variable revealed highly significant correlations between the paraspinal musculature PDFF at C3 (men: r = 0.504, p = 0.007; women: r = 0.279, p = 0.028), C5 (men: r = 0.450, p = 0.019; women: r = 0.347, p = 0.006) and Th1 (men: r = 0.652, p < 0.0001; women: r = 0.443, p < 0.0001) with age in both genders. CONCLUSION The present data suggest gender and age-specific fat deposition patterns of the cervical and the upper cervicothoracic paraspinal muscles and may provide reference values for pathology detection.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Christina Holzapfel
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Theresa Drabsch
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Hans Hauner
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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25
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Hou X, Lu S, Wang B, Kong C, Hu H. Morphologic Characteristics of the Deep Cervical Paraspinal Muscles in Patients with Single-Level Cervical Spondylotic Myelopathy. World Neurosurg 2020; 134:e166-e171. [DOI: 10.1016/j.wneu.2019.09.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
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26
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Weber KA, Smith AC, Wasielewski M, Eghtesad K, Upadhyayula PA, Wintermark M, Hastie TJ, Parrish TB, Mackey S, Elliott JM. Deep Learning Convolutional Neural Networks for the Automatic Quantification of Muscle Fat Infiltration Following Whiplash Injury. Sci Rep 2019; 9:7973. [PMID: 31138878 PMCID: PMC6538618 DOI: 10.1038/s41598-019-44416-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Muscle fat infiltration (MFI) of the deep cervical spine extensors has been observed in cervical spine conditions using time-consuming and rater-dependent manual techniques. Deep learning convolutional neural network (CNN) models have demonstrated state-of-the-art performance in segmentation tasks. Here, we train and test a CNN for muscle segmentation and automatic MFI calculation using high-resolution fat-water images from 39 participants (26 female, average = 31.7 ± 9.3 years) 3 months post whiplash injury. First, we demonstrate high test reliability and accuracy of the CNN compared to manual segmentation. Then we explore the relationships between CNN muscle volume, CNN MFI, and clinical measures of pain and neck-related disability. Across all participants, we demonstrate that CNN muscle volume was negatively correlated to pain (R = -0.415, p = 0.006) and disability (R = -0.286, p = 0.045), while CNN MFI tended to be positively correlated to disability (R = 0.214, p = 0.105). Additionally, CNN MFI was higher in participants with persisting pain and disability (p = 0.049). Overall, CNN's may improve the efficiency and objectivity of muscle measures allowing for the quantitative monitoring of muscle properties in disorders of and beyond the cervical spine.
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Affiliation(s)
- Kenneth A Weber
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA.
| | - Andrew C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Marie Wasielewski
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kamran Eghtesad
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Pranav A Upadhyayula
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University, Palo Alto, CA, USA
| | - Trevor J Hastie
- Statistics Department, Stanford University, Palo Alto, CA, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Honorary Senior Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Northern Sydney Local Health District, The Kolling Research Institute and The Faculty of Health Sciences, The University of Sydney, St. Leonards, NSW, Australia
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Machine Learning for the Prediction of Cervical Spondylotic Myelopathy: A Post Hoc Pilot Study of 28 Participants. World Neurosurg 2019; 127:e436-e442. [PMID: 30922901 DOI: 10.1016/j.wneu.2019.03.165] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) severity and presence of symptoms are often difficult to predict based simply on clinical imaging alone. Similarly, improved machine learning techniques provide new tools with immense clinical potential. METHODS A total of 14 patients with CSM and 14 controls underwent imaging of the cervical spine. Two different artificial neural network models were trained; 1) to predict CSM diagnosis; and 2) to predict CSM severity. Model 1 consisted of 6 inputs including 3 common imaging scales for the evaluation of cord compression, alongside 3 objective magnetic resonance imaging measurements. The outcome for model 1 was binary to predict CSM diagnosis. Model 2 consisted of 23 input variables derived from probabilistic volume mapping measurements of white matter tracts in the region of compression. The outcome of model 2 was linear, to predict the modified Japanese Orthopedic Association (mJOA) score. RESULTS Model 1 was used in predicting CSM. The mean cross-validated accuracy of the trained model was 86.50% (95% confidence interval, 85.16%-87.83%) with a median accuracy of 90.00%. Area under the curve (AUC) was calculated for each repetition. Average AUC for each repetition was 0.947 with a median AUC of 1.0. Average sensitivity, specificity, positive predictive value, and negative predictive value were 90.25%, 85.05%, 81.58%, and 91.94%, respectively. Model 2 was used in modeling mJOA. The mJOA model predicted scores, with a mean and median error of -0.29 mJOA points and -0.08 mJOA points, respectively, mean error per batch was 0.714 mJOA points. CONCLUSIONS Machine learning provides a promising method for prediction, diagnosis, and even prognosis in patients with CSM.
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