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Buffet-García J, Plaza-Manzano G, Varol U, Ríos-León M, Díaz-Arribas MJ, Álvarez-González J, Sánchez-Jorge S, Valera-Calero JA. Reliability of Panoramic Ultrasound in Assessing Rectus Femoris Size, Shape, and Brightness: An Inter-Examiner Study. Bioengineering (Basel) 2024; 11:82. [PMID: 38247959 PMCID: PMC10813357 DOI: 10.3390/bioengineering11010082] [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: 12/05/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Extended field-of-view ultrasound (US) imaging, also known as panoramic US, represents a technical advance that allows for complete visualization of large musculoskeletal structures, which are often limited in conventional 2D US images. Currently, there is no evidence examining whether the experience of examiners influences muscle shape deformations that may arise during the glide of the transducer in panoramic US acquisition. As no studies using panoramic US have analyzed whether two examiners with differing levels of experience might obtain varying scores in size, shape, or brightness during the US assessment of the rectus femoris muscle, our aim was to analyze the inter-examiner reliability of panoramic US imaging acquisition in determining muscle size, shape, and brightness between two examiners. Additionally, we sought to investigate whether the examiners' experience plays a significant role in muscle deformations during imaging acquisition by assessing score differences. Shape (circularity, aspect ratio, and roundness), size (cross-sectional area and perimeter), and brightness (mean echo intensity) were analyzed in 39 volunteers. Intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), and coefficient of absolute errors (CAE%) were calculated. All parameters evaluated showed no significant differences between the two examiners (p > 0.05). Panoramic US proved to be reliable, regardless of examiner experience, as no deformations were observed. Further research is needed to corroborate the validity of panoramic US by comparing this method with gold standard techniques.
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Affiliation(s)
- Jorge Buffet-García
- Department of Physiotherapy, Faculty of Health, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.B.-G.); (J.Á.-G.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.D.-A.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla-La Mancha (SESCAM), 45004 Toledo, Spain;
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45004 Toledo, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.D.-A.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Javier Álvarez-González
- Department of Physiotherapy, Faculty of Health, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.B.-G.); (J.Á.-G.)
| | - Sandra Sánchez-Jorge
- Department of Physiotherapy, Faculty of Health, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.B.-G.); (J.Á.-G.)
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.D.-A.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 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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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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Elliott JM, Walton DM, Albin SR, Courtney DM, Siegmund GP, Carroll LJ, Weber KA, Smith AC. Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision. Spine J 2023; 23:1028-1036. [PMID: 36958668 PMCID: PMC10330498 DOI: 10.1016/j.spinee.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND CONTEXT Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING A cohort study, single-center academic hospital. PATIENT SAMPLES A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE Neck disability at 12-months. METHODS Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02157038.
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Affiliation(s)
- J M Elliott
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, The Kolling Institute, 10 Westbourne St, St Leonards, New South Wales, 2065, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Chicago, IL 60611, USA.
| | - D M Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University Canada Schulich School of Medicine and Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada; Department of Psychiatry, Western University Canada, 151 Richmond St, London, Ontario N6A 5C1, Canada
| | - S R Albin
- School of Physical Therapy, Regis University, 3333 Regis Boulevard Denver, CO 80221-1099, USA
| | - D M Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - G P Siegmund
- MEA Forensics, 11151 Horseshoe Way, Richmond, British Columbia V7A 4S5, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - K A Weber
- Division of Pain Medicine, Stanford School of Medicine, 900 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - A C Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
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Antonio Valera-Calero J, Plaza-Manzano G, Ortega-Santiago R, Fernández-de-Las-Peñas C, Varol U. Panoramic ultrasound imaging does not produce muscle morphology deformation during imaging acquisition: A validity study. Phys Med 2023; 106:102530. [PMID: 36634596 DOI: 10.1016/j.ejmp.2023.102530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Despite panoramic ultrasound imaging (US) is a promising advance for the morphological and histological assessment of large musculature which cannot be entirely assessed using B-mode, there is no evidence assessing if this technology produces muscle deformation during imaging acquisition. We aimed to analyze differences in size, shape and brightness descriptors between B-mode and panoramic US images and to assess the concordance between both methods. Methods We analyzed size (cross-sectional area and perimeter), shape (circularity, aspect ratio and roundness) and brightness (mean echo-intensity) features of cervical multifidus (CM) and short rotators (SR) in 46 healthy volunteers. Images were acquired in B-mode and extended field-of-view mode. For validity analysis, mean differences between methods were calculated. For agreement analysis, intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated. RESULTS All parameters showed no significant differences between both methods for either CM or SR (P > 0.05). Panoramic US showed excellent concordance with B-mode for assessing all CM parameters (all ICCs > 0.9), while for SR the agreement ranged from good-to-excellent (ICC from 0.861 to 0.978). CONCLUSION Panoramic US seems to be a valid tool for assessment of muscle size, shape and brightness as no deformation in comparison with B-mode images was seen. Further research is needed to corroborate these findings comparing panoramic US imaging with Gold Standard methods.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
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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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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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8
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Khattab K, Dziesinski LK, Crawford R, Ballatori A, Nyayapati P, Krug R, Fields A, O'Neill CW, Lotz JC, Bailey JF. Spatial distribution of fat infiltration within the paraspinal muscles: implications for chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2875-2883. [PMID: 35776179 PMCID: PMC9637053 DOI: 10.1007/s00586-022-07296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/11/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Fat infiltration (FI) of the paraspinal muscles (PSMs) measured using MRI is an aspect of muscle quality and is considered to be worse in chronic low back pain (cLBP) patients. However, there is not a clear association between paraspinal muscle FI and cLBP, leaving the clinical importance of paraspinal muscle composition unestablished. The spatial distribution of FI in the PSMs may inform mechanistic understanding of non-specific cLBP as it relates to degenerative intervertebral disc (IVD) pathology. We hypothesized that paraspinal muscle fat-mapping would reveal distinct FI distribution patterns in relation to cLBP symptoms and proximity to symptomatic IVD degeneration. METHODS From advanced-sequence water-fat MRI of 40 axial cLBP patients and 21 controls, we examined the spatial distribution of paraspinal muscle FI in relation to the center of rotation at the L4L5 disc. Using statistical parametric mapping, we compared FI patterns for multifidus (MF), erector spinae (ES), and psoas between patients and controls, and to the presence and severity of adjacent degenerative IVD pathology. RESULTS The spatial distribution of PSMs FI differs between PSMs and according to symptoms and the adjacent degenerative IVD pathology. Furthermore, the region of MF closest to the disc center of rotation appears most susceptible to FI in the presence of symptomatic IVD degeneration. CONCLUSION Our study identified spatial distribution patterns of FI in the PSMs as a potential diagnostic biomarker that may also provide granular mechanistic insights into spine biomechanics related to cLBP, as well as advancing the use of prior summary measures limited to overall muscle FI.
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Affiliation(s)
- Karim Khattab
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Lucas K Dziesinski
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | | | - Alex Ballatori
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Priya Nyayapati
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Roland Krug
- Department of Radiology, University of California, San Francisco, USA
| | - Aaron Fields
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Conor W O'Neill
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco 95 Kirkham St, San Francisco, CA, 94122, USA.
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9
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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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10
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Valera-Calero JA, Fernández-de-Las-Peñas C, Cleland JA, Varol U, Ortega-Santiago R, Arias-Buría JL. Ultrasound assessment of deep cervical extensors morphology and quality in populations with whiplash associated disorders: An intra- and inter-examiner reliability study. Musculoskelet Sci Pract 2022; 59:102538. [PMID: 35272960 DOI: 10.1016/j.msksp.2022.102538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound imaging (US) has shown to be a reliable and valid tool for assessing muscle morphology and quality. However, most studies have focused on asymptomatic populations. OBJECTIVE To investigate intra- and inter-rater reliability estimates of muscle morphology and quality of cervical multifidus (CM) and short rotators (SR) in patients with whiplash associated disorders (WAD). DESIGN An intra- and inter-examiner reliability study. METHODS US images were acquired in a blinded fashion in 34 patients (35% males) by two experienced and two novice examiners. Cross-sectional area (CSA), perimeter, mean echo-intensity (EI) and the percentage of fatty infiltration were assessed twice, one-week apart, in a randomized order. Reliability estimates (i.e., intra-class correlation coefficients -ICC-, standard error of measurement -SEM-, minimal detectable change, mean of measurements, absolute and percent errors) were calculated. RESULTS Intra-examiner reliability for experienced assessors ranged from good to excellent for CM and SR (ICC3,1 = 0.888-0.975 and 0.810-0.964 respectively) and from moderate-to-good for novices (ICC3,1 = 0.708-0.790 and 0.655-0.796 respectively). The agreement between the experienced examiners was moderate to good (ICC3,2 = 0.737-0.899 and 0.728-0.899 CM and SR respectively); between novice and experienced examiners was moderate to good (ICC3,2 = 0.617-0.873 and 0.657-0.766 CM and SR respectively); and between novice examiners was moderate-to-good for CM (ICC3,2 = 0.610-0.777) and moderate for SR (ICC3,2 = 0.600-0.730). CONCLUSION CM and SR intra-examiner reliability was good-to-excellent for novice and experienced examiners. However, inter-examiner reliability was clinically acceptable just for experienced examiners at the C4/C5 level in WAD populations.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain; VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Mass, USA
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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11
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Uhrenholt L, Brix L, Wichmann TO, Pedersen M, Ringgaard S, Jensen TS. Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study. Chiropr Man Therap 2022; 30:2. [PMID: 34996490 PMCID: PMC8742358 DOI: 10.1186/s12998-022-00410-y] [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: 08/10/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. METHODS Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher's exact test, Mann Whitney U test and analysis of variance between groups. RESULTS The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. CONCLUSIONS This study did not show that MRI-based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark. .,Nortvig & Uhrenholt Kiropraktisk Klinik, 8200, Aarhus, Denmark.
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Department of Procurement and Biomedical Engineering, Region Midt, Aarhus N, Denmark
| | | | - Michael Pedersen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- MR Research Centre, Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tue Secher Jensen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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12
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Dickson C, de Zoete RMJ, Stanton TR. From Where We've Come to Where We Need to Go: Physiotherapy Management of Chronic Whiplash-Associated Disorder. FRONTIERS IN PAIN RESEARCH 2022; 2:795369. [PMID: 35295440 PMCID: PMC8915571 DOI: 10.3389/fpain.2021.795369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Cameron Dickson
| | - Rutger M. J. de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
| | - Tasha R. Stanton
- Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
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13
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Valera-Calero JA, Úbeda-D'Ocasar E, Caballero-Corella M, Fernández-de-Las-Peñas C, Sendarrubias GMG, Arias-Buría JL. Cervical Multifidus Morphology and Quality is not Associated with Clinical Variables in Women with Fibromyalgia: An Observational Study. PAIN MEDICINE 2021; 23:1138-1143. [PMID: 34633451 DOI: 10.1093/pm/pnab297] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Some studies have reported the presence of histological alterations such as myofibers disorganization and abnormalities in the number and shape of mitochondria in patients with fibromyalgia syndrome (FMS). Although Ultrasound imaging (US) is used to quantitatively characterize muscle tissues, US studies in patients with FMS are lacking. Therefore, we aimed to describe morphological and qualitative cervical multifidus (CM) muscle US features in women with FMS and to assess their correlation with clinical indicators. DESIGN Observational study. SETTING AFINSYFACRO Fibromyalgia Association (Madrid, Spain). SUBJECTS Forty-five women with FMS participated. METHODS Sociodemographic (e.g., age, height, weight, and BMI), clinical (e.g., pain -NPRS-, evolution time, related-disability -FIQ-) outcomes were collected. Images were acquired bilaterally at the cervical spine (C4-C5 level) and measured by an experienced examiner for assessing muscle morphology (e.g., cross-sectional area -CSA-, perimeter and shape) and quality (mean echo-intensity -EI- and intramuscular fatty infiltration -FI-). Side-to-side comparisons and a correlational analysis were conducted. RESULTS No significant side-to-side differences were found for morphology nor quality features (P > 0.05). None of the clinical indicators were associated with US characteristics (all, P > 0.05). CONCLUSION Our results showed no side-to-side differences for CM morphology and quality as assessed with US. No associations between CM muscle morphology nor quality with FIQ, PPT, NPRS nor evolution time were observed. Our preliminary data suggest that muscle morphology is not directly related to pain and related-disability in women with FMS.
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Affiliation(s)
| | - Edurne Úbeda-D'Ocasar
- Department of Physical Therapy, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
| | - Mario Caballero-Corella
- Department of Physical Therapy, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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14
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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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15
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Echo-intensity, fatty infiltration, and morphology ultrasound imaging assessment in healthy and whiplash associated disorders populations: an observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3059-3067. [PMID: 34218342 DOI: 10.1007/s00586-021-06915-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/24/2021] [Accepted: 06/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although changes in muscle morphology and quality in deep neck flexors seem to be clear in patients with whiplash-associated disorders (WAD), evidence for deep neck extensors is heterogeneous. In addition, most studies have used magnetic resonance imaging or computer tomography, which is not available for regular practice. OBJECTIVES To assess differences in deep neck extensors morphology and quality between patients with WAD and controls with ultrasound imaging (US) and to assess the association of imaging findings with clinical features. METHODS One hundred and sixty brightness-mode images at C4/C5 level were acquired in 41 patients with WAD and 39 pain-free controls. Muscle morphology and quality characteristics of the cervical multifidus (CM) and short rotators (SR), clinical pain features and pressure pain thresholds (PPT) were assessed in a blinded design. RESULTS Between-groups differences in both CM and SR were observed for fatty infiltration percentage (mean: 4.9%; P < 0.001; mean: 3.5%; P < 0.05, respectively) and mean EI (mean: 4.1; P < 0.001; mean: 3.2; P < 0.05, respectively): patients exhibited higher fatty infiltration than controls. The intensity of neck pain was negatively associated with multifidus CSA and perimeter (P < 0.001); symptoms duration was negatively associated with CM morphology (P < 0.001), CM mean EI (P < 0.05) and SR morphology (P < 0.05); pain-related disability was associated with CM morphology (P < 0.001) and SR mean EI (P < 0.05); and PPTs was associated with CM mean EI (P < 0.01) and FI (p < 0.05) and SR morphology (P < 0.001). No significant effect of gender was found in any analysis. CONCLUSION US assessment of deep cervical extensors revealed greater fatty infiltration, but no differences in muscle morphology, between WAD patients and pain-free controls.
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16
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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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17
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Elliott JM, Rueckeis CA, Pan Y, Parrish TB, Walton DM, Linnstaedt SD. microRNA let-7i-5p mediates the relationship between muscle fat infiltration and neck pain disability following motor vehicle collision: a preliminary study. Sci Rep 2021; 11:3140. [PMID: 33542428 PMCID: PMC7862492 DOI: 10.1038/s41598-021-82734-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023] Open
Abstract
Persistent neck-pain disability (PNPD) is common following traumatic stress exposures such as motor vehicle collision (MVC). Substantial literature indicates that fat infiltration into neck muscle (MFI) is associated with post-MVC PNPD. However, little is known about the molecular mediators underlying this association. In the current study, we assessed whether microRNA expression signatures predict PNPD and whether microRNA mediate the relationship between neck MFI and PNPD. A nested cohort of 43 individuals from a longitudinal study of MVC survivors, who provided blood (PAXgene RNA) and underwent magnetic resonance imaging (MRI), were included in the current study. Peritraumatic microRNA expression levels were quantified via small RNA sequencing, neck MFI via MRI, and PNPD via the Neck Disability Index two-weeks, three-months, and twelve-months following MVC. Repeated measures regression models were used to assess the relationship between microRNA and PNPD and to perform mediation analyses. Seventeen microRNA predicted PNPD following MVC. One microRNA, let-7i-5p, mediated the relationship between neck MFI and PNPD. Peritraumatic blood-based microRNA expression levels predict PNPD following MVC and let-7i-5p might contribute to the underlying effects of neck MFI on persistent disability. In conclusion, additional studies are needed to validate this finding.
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Affiliation(s)
- James M Elliott
- Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cathleen A Rueckeis
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA
| | - Yue Pan
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Todd B Parrish
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA.
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
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