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Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure. Diagnostics (Basel) 2024; 14:957. [PMID: 38732372 PMCID: PMC11082978 DOI: 10.3390/diagnostics14090957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to an MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. METHODS Three spine clinic records were reviewed over a 2-year period, looking for patients where both an initial lateral cervical X-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards, an additional exam and radiographic analysis were obtained. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain's line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. RESULTS There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear-end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p < 0.001. The NDI was available on 24/41 (58.5%) patients and increased after the MVC from 15.7% to 32.8%, p < 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in the mean radius of curvature (265.5 vs. 555.5, p < 0.001) and an approximate 8° reduction of lordosis from C2-C7; p < 0.001. The mid-cervical spine (C3-C5) showed the greatest curve reduction with an averaged localized mild kyphosis at these levels. Four participants (10%) developed segmental translations that were just below the threshold of instability, segmental translations < 3.5 mm. CONCLUSIONS The post-exposure MVC cervical curvature was characterized by an increase in radius of curvature, an approximate 8° reduction in C2-C7 lordosis, a mild kyphosis of the mid-cervical spine, and a slight increase in anterior translation of C2-C7 sagittal balance. The modelling result indicates that the post-MVC cervical sagittal alignment approximates a second-order buckling alignment, indicating a significant alteration in curve geometry. Future biomechanics experiments and clinical investigations are needed to confirm these findings.
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Affiliation(s)
- Jason W. Haas
- Chiropractic Biophysics NonProfit, Inc., Eagle, ID 83616, USA
| | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J1P3, Canada;
| | | | | | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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Shearer HM, Carroll LJ, Côté P, Randhawa K, Southerst D, Varatharajan S, Wong JJ, Yu H, Sutton D, van der Velde G, Nordin M, Gross DP, Mior S, Stupar M, Jacobs C, Taylor-Vaisey A. The course and factors associated with recovery of whiplash-associated disorders: an updated systematic review by the Ontario protocol for traffic injury management (OPTIMa) collaboration. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1736150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Heather M. Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Linda J. Carroll
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | | | - Danielle Southerst
- Occupational and Industrial Orthopaedic Centre, NYU Langone Orthopaedic Hospital, NY, USA
| | - Sharanya Varatharajan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
- Institute for Work and Health, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center of NYU School of Medicine, New York University, NY, USA
| | - Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Silvano Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Maja Stupar
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Craig Jacobs
- Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
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Elliott JM, Cornwall J, Kennedy E, Abbott R, Crawford RJ. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskelet Disord 2018; 19:171. [PMID: 29807530 PMCID: PMC5972401 DOI: 10.1186/s12891-018-2074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.
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Affiliation(s)
- James M Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Australia 75 East Street Lidcombe NSW, Sydney, 2141, Australia. .,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Honorary Fellow School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Hill L, Aboud D, Elliott J, Magnussen J, Sterling M, Steffens D, Hancock MJ. Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review. Spine J 2018; 18:880-891. [PMID: 29412188 DOI: 10.1016/j.spinee.2018.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear. PURPOSE We aimed to investigate whether findings on cervical spine MRI predict future neck pain. STUDY DESIGN A systematic review was carried out. PATIENT SAMPLE People with or without neck pain comprised the study sample. OUTCOME MEASURES Clinically important neck pain outcomes such as pain and disability. METHODS The review protocol was registered on PROSPERO [CRD42016049228]. MEDLINE, CINAHL, and EMBASE databases were searched. Prospective cohort studies investigating the association between baseline MRI findings and clinical outcome were included. Cohorts with serious underlying diseases as the cause of their neck pain were excluded. Associations between MRI findings and neck pain outcomes were extracted from the included studies. RESULTS A total of 12 studies met all inclusion criteria. Eight studies presented data on participants with current neck pain, two studies included a mixed sample, and two studies included a sample of participants with no current neck pain. Because of the heterogeneity between the studies in terms of MRI findings, populations, and clinical outcomes investigated, it was not possible to pool the results. No consistent associations between MRI findings and future outcomes were identified. Single studies of populations with neck pain reported significant associations for neck muscle fatty infiltrate (risk ratio [RR]: 21.00, 95% confidence interval [CI]: 2.97-148.31) with persistent neck disability; disc protrusion (mean difference ranged from -1.83 to -2.88 on a 10-point pain scale), and disc degeneration (RR: 0.59; 95% CI: 0.36-0.98) with neck pain. In a population without pain, the development of foraminal stenosis over a 10-year period was associated with development of neck pain (RR: 2.99; 95% CI: 1.23-7.23). CONCLUSION The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain.
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Affiliation(s)
- Laura Hill
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - David Aboud
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - James Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Sydney, 2065, Australia; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Magnussen
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - Michele Sterling
- Recover Injury Research Centre and Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, QLD 4072, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney Medical School, The Univeristy of Sydney, Sydney, NSW 2050, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia.
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John JD, Yoganandan N, Arun MWJ, Saravana Kumar G. Influence of morphological variations on cervical spine segmental responses from inertial loading. TRAFFIC INJURY PREVENTION 2018; 19:S29-S36. [PMID: 29584503 DOI: 10.1080/15389588.2017.1403017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the influence of morphological variations in osteoligamentous lower cervical spinal segment responses under postero-anterior inertial loading. METHODS A parametric finite element model of the C5-C6 spinal segment was used to generate models. Variations in the vertebral body and facet depth (anteroposterior), posterior process length, intervertebral disc height, facet articular process height and slope, segment orientation ranging from lordotic to straight, and segment size were parameterized. These variations included male-female differences. A Latin hypercube sampling method was used to select parameter values for model generation. Forces and moments associated with the inertial loading were applied to the generated model segments. The 7 parameters were grouped as local or global depending on the number of spinal components involved in the shape variation. Four output responses representing overall segmental and soft tissue responses were analyzed for each model variation: response angle of the segment, anterior longitudinal ligament stretch, anterior capsular ligament stretch, and facet joint compression in the posterior region. Pearson's correlation coefficient was used to compute the correlations of these output responses with morphological variations. RESULTS Fifty models were generated from the parameterized model using a Latin hypercube sampling technique. Variation in response angle among the models was 4° and was most influenced by change in the combined dimension of vertebral body and facet depth, followed by size of the segment. The maximum anterior longitudinal ligament stretch varied between 0.1 and 0.3 and was strongly influenced by the change in the segment orientation. The anterior facet joint region sustained tension, whereas the posterior region sustained compression. For the anterior capsular ligament stretch, the most influential global variation was segment orientation, whereas the most influential local variations were the facet height and facet angle parameters. In the case of posterior facet joint compression, segment orientation was again most influential, whereas among the local variations, the facet angle had the most influence. CONCLUSION Shape variations in the intervertebral disc influenced segmental rotation and ligament responses; however, the influence of shape variations in the facet joint was confined to capsular ligament responses. Response angle was most influenced by the vertebral body depth variations, explaining greater segmental rotations in female spines. Straighter spine segments sustained greater posterior facet joint compression, which may offer an explanation for the higher incidence of whiplash-associated disorders among females, who exhibit a straighter cervical spine. The anterior longitudinal ligament stretch was also greater in straighter segments. These findings indicate that the morphological features specific to the anatomy of the female cervical spine may predispose it to injury under inertial loading.
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Affiliation(s)
- Jobin D John
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
- b Department of Engineering Design , Indian Institute of Technology Madras , Chennai , India
| | - Narayan Yoganandan
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
- c Department of Orthopedic Surgery, Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Mike W J Arun
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - G Saravana Kumar
- b Department of Engineering Design , Indian Institute of Technology Madras , Chennai , India
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.
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Abstract
Synopsis Despite considerable research effort, the incidence of whiplash injury during automotive collisions has continued to rise. This is due, at least in part, to a limited recognition of biomechanical injury mechanisms and factors influencing injury risk. While automotive safety modifications reduced injury risk in some cases, impact on the overall whiplash incidence was limited. This is likely attributable to significant occupant-related differences that have a profound impact on injury risk. Many of those differences were outlined in research studies, and examples include female sex and the associated sex-based anthropometrical variation that can affect seating orientation; cervical spinal posture; and anatomical attributes, including cervical column slenderness and neck muscle morphometry. This review highlights these anatomical attributes and explains, based on biomechanical concepts, the method by which these attributes may alter cervical spine response during automotive rear impacts to affect injury risk. The biomechanical explanations are based on existing studies that have incorporated postmortem human subjects, computational models, and anthropomorphic test devices (ie, crash test dummies), as well as medical imaging in human volunteers. These biomechanical explanations may provide improved understanding of injury risk. J Orthop Sports Phys Ther 2016;46(10):834-844. doi:10.2519/jospt.2016.6846.
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