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McKay MJ, Weber KA, Wesselink EO, Smith ZA, Abbott R, Anderson DB, Ashton-James CE, Atyeo J, Beach AJ, Burns J, Clarke S, Collins NJ, Coppieters MW, Cornwall J, Crawford RJ, De Martino E, Dunn AG, Eyles JP, Feng HJ, Fortin M, Franettovich Smith MM, Galloway G, Gandomkar Z, Glastras S, Henderson LA, Hides JA, Hiller CE, Hilmer SN, Hoggarth MA, Kim B, Lal N, LaPorta L, Magnussen JS, Maloney S, March L, Nackley AG, O’Leary SP, Peolsson A, Perraton Z, Pool-Goudzwaard AL, Schnitzler M, Seitz AL, Semciw AI, Sheard PW, Smith AC, Snodgrass SJ, Sullivan J, Tran V, Valentin S, Walton DM, Wishart LR, Elliott JM. MuscleMap: An Open-Source, Community-Supported Consortium for Whole-Body Quantitative MRI of Muscle. J Imaging 2024; 10:262. [PMID: 39590726 PMCID: PMC11595196 DOI: 10.3390/jimaging10110262] [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: 06/27/2024] [Revised: 09/11/2024] [Accepted: 10/18/2024] [Indexed: 11/28/2024] Open
Abstract
Disorders affecting the neurological and musculoskeletal systems represent international health priorities. A significant impediment to progress in trials of new therapies is the absence of responsive, objective, and valid outcome measures sensitive to early disease changes. A key finding in individuals with neuromuscular and musculoskeletal disorders is the compositional changes to muscles, evinced by the expression of fatty infiltrates. Quantification of skeletal muscle composition by MRI has emerged as a sensitive marker for the severity of these disorders; however, little is known about the composition of healthy muscles across the lifespan. Knowledge of what is 'typical' age-related muscle composition is essential to accurately identify and evaluate what is 'atypical'. This innovative project, known as the MuscleMap, will achieve the first important steps towards establishing a world-first, normative reference MRI dataset of skeletal muscle composition with the potential to provide valuable insights into various diseases and disorders, ultimately improving patient care and advancing research in the field.
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Affiliation(s)
- Marnee J. McKay
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Kenneth A. Weber
- Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94304, USA; (K.A.W.II); (E.O.W.)
| | - Evert O. Wesselink
- Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA 94304, USA; (K.A.W.II); (E.O.W.)
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences—Program Musculoskeletal Health, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Zachary A. Smith
- Department of Rehabilitation Medicine, University of Oklahoma, Norman, OK 73019, USA;
| | - Rebecca Abbott
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - David B. Anderson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Claire E. Ashton-James
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - John Atyeo
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Aaron J. Beach
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia; (A.J.B.); (J.S.M.)
| | - Joshua Burns
- Disability Prevention Program, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Stephen Clarke
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Natalie J. Collins
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
| | - Michel W. Coppieters
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia; (M.W.C.); (J.A.H.)
| | - Jon Cornwall
- Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
| | | | - Enrico De Martino
- Department of Health Science and Technology, Aalborg University, Gistrup, 9260 North Jutland, Denmark;
| | - Adam G. Dunn
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Jillian P. Eyles
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
- Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
| | - Henry J. Feng
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada;
| | - Melinda M. Franettovich Smith
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
| | - Graham Galloway
- Herston Imaging Research Facility, University of Queensland, Brisbane, QLD 4072, Australia;
| | - Ziba Gandomkar
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Sarah Glastras
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
- Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
| | - Luke A. Henderson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Julie A. Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia; (M.W.C.); (J.A.H.)
| | - Claire E. Hiller
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Sarah N. Hilmer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Mark A. Hoggarth
- Department of Physical Therapy, North Central College, Naperville, IL 60540, USA;
| | - Brian Kim
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
- Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
| | - Navneet Lal
- Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
| | - Laura LaPorta
- School of Rehabilitative and Health Sciences, Regis University, Denver, CO 80221, USA;
| | - John S. Magnussen
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia; (A.J.B.); (J.S.M.)
| | - Sarah Maloney
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Lyn March
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Andrea G. Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, School of Medicine, Duke University, Durham, NC 27710, USA;
| | - Shaun P. O’Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
| | - Anneli Peolsson
- Occupational and Environmental Medicine Centre, Department of Health Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, 58183 Linköping, Sweden;
- Department of Health Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, 58183 Linköping, Sweden
| | - Zuzana Perraton
- School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; (Z.P.); (A.I.S.)
| | - Annelies L. Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences—Program Musculoskeletal Health, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Margaret Schnitzler
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Amee L. Seitz
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Adam I. Semciw
- School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; (Z.P.); (A.I.S.)
| | - Philip W. Sheard
- Otago Medical School, University of Otago, Dunedin 9016, New Zealand; (J.C.); (P.W.S.)
| | - Andrew C. Smith
- School of Medicine, University of Colorado, Aurora, CO 80045, USA;
| | - Suzanne J. Snodgrass
- Discipline of Physiotherapy, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Justin Sullivan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
| | - Vienna Tran
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Stephanie Valentin
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland EH11 4BN, UK;
| | - David M. Walton
- School of Physical Therapy, Western University, London, ON N6A 3K7, Canada;
| | - Laurelie R. Wishart
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD, Australia; (N.J.C.); (M.M.F.S.); (S.P.O.); (L.R.W.)
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
| | - James M. Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.B.A.); (C.E.A.-J.); (J.A.); (S.C.); (A.G.D.); (J.P.E.); (H.J.F.); (Z.G.); (S.G.); (L.A.H.); (C.E.H.); (S.N.H.); (B.K.); (S.M.); (L.M.); (M.S.); (J.S.); (J.M.E.)
- Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW 2065, Australia
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Anderson DB, Beach AJ, Chen L, Feng HJ, McKay MJ, Smith ZA, Weber KA, Wesselink EO, Elliott JM. What is normal age-related thigh muscle composition among 45- to 84-year-old adults from the UK Biobank study. GeroScience 2024:10.1007/s11357-024-01304-y. [PMID: 39133460 DOI: 10.1007/s11357-024-01304-y] [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: 04/03/2024] [Accepted: 07/28/2024] [Indexed: 08/13/2024] Open
Abstract
A loss of skeletal muscle mass and an increase in intramuscular fat are known to occur as we enter middle and older age, but the expected changes or normative values have remained unknown. The primary reason for this is that imaging studies are difficult and expensive to conduct, and consequently, the sample sizes have remained small. The development of the UK Biobank which provides access to a large magnetic resonance imaging (MRI) data set of more than 50,000 participants provides an opportunity to finally address this question of normative values for each age group. The study's primary aim was to determine the age-related changes in thigh muscle composition (e.g., thigh fat-free muscle volume and intramuscular fat) between the ages of 45 and 84 years. The second aim was to analyse associations between thigh fat-free muscle volume and intramuscular fat with lifestyle behaviours (smoking, alcohol consumption, and physical activity), leg pain, and bone mineral density. Fifty thousand three hundred thirty-two participants were included in the study. Total fat-free thigh muscle declined between the ages of 45 and 84 years, while intramuscular fat of the thigh continued to increase. The changes were stable between these age groups. The mean volume of fat-free muscle ranged from 11.16 (SD: 1.40) to 13.26 L (SD: 1.85) in adult males and 7.60 (SD: 0.97) to 8.80 L (SD 1.29) in females between the ages of 45 and 84 years. For intramuscular fat, the change among women was from 6.94% (SD: 1.59) in the 45 to 54 years age bracket to 8.83% (SD: 1.92) in the 75 to 84 age bracket, while for men, it was 5.83% (SD: 1.30) in the 45 to 54 age bracket to 7.85% (SD 1.89) in the 75 to 84 age bracket. The total fat-free muscle volume and intramuscular fat percentage provided can be used for the purpose of reference standards or normative values for adults in the age groups provided. Fat-free muscle and intramuscular fat were found to be associated with a range of health, activity, and leg pain outcomes, and these should be investigated in a follow-up longitudinal imaging study.
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Affiliation(s)
- David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Aaron J Beach
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lingxiao Chen
- Department of Orthopaedics, Shandong University Centre for Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Henry J Feng
- University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Sydney, Australia
| | - Marnee J McKay
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zachary A Smith
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73116, USA
| | - Kenneth A Weber
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Evert Onno Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - James M Elliott
- University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Sydney, Australia
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Snodgrass SJ, Weber KA, Wesselink EO, Stanwell P, Elliott JM. Reduced Cervical Muscle Fat Infiltrate Is Associated with Self-Reported Recovery from Chronic Idiopathic Neck Pain Over Six Months: A Magnetic Resonance Imaging Longitudinal Cohort Study. J Clin Med 2024; 13:4485. [PMID: 39124753 PMCID: PMC11312969 DOI: 10.3390/jcm13154485] [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: 05/13/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared muscle composition quantified from fat-water magnetic resonance images from the C3 to T1 vertebrae in individuals with and without chronic idiopathic neck pain at two times 6 months apart. Those with neck pain received six weeks of intervention (physiotherapy or chiropractic) after their baseline MRI; at 6 months, they were classified as recovered (≥3 on the 11-point Global Rating of Change scale) or not recovered. Results: At 6 months, both asymptomatic and recovered individuals had decreased MFI compared to baseline (asymptomatic estimated marginal mean difference -1.6% 95%; CI -1.9, -1.4; recovered -1.6; -1.8, -1.4; p < 0.001) whereas those classified as not recovered had increased MFI compared to baseline (0.4; 0.1, 0.7; p = 0.014), independent of age, sex and body mass index. Conclusions: It appears MFI decreases with recovery from neck pain but increases when neck pain persists. The relationship between cervical MFI and neck pain suggests MFI may inform diagnosis, theragnosis and prognosis in individuals with neck pain. Future development of a clinical test for MFI may assist in identifying patients who will benefit from targeted muscle intervention, improving outcomes.
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Affiliation(s)
- Suzanne J. Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan 2308, Australia
- Centre for Active Living and Learning, Hunter Medical Research Institute, New Lambton Heights 2305, Australia
| | - Kenneth A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | | | - Peter Stanwell
- Discipline of Medical Radiation Science (Diagnostic Radiography), The University of Newcastle, Callaghan 2308, Australia;
| | - James M. Elliott
- The Kolling Institute, Northern Sydney (Arabanoo) Precinct, St Leonards 2065, Australia;
- Sydney School of Health Sciences, The University of Sydney, Camperdown 2050, Australia
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Ma Y, Zhao D, Yu X, Yue X, Meng L, Xu L, Qiu Z, Feng N, Jiang G. Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF. J Orthop Surg Res 2024; 19:435. [PMID: 39061068 PMCID: PMC11282861 DOI: 10.1186/s13018-024-04935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To explore the feasibility of applying CT Hounsfield Units (HUs) for the assessment of preoperative paraspinal muscle fat infiltration (FI) in different segments in patients who underwent anterior cervical discectomy and fusion (ACDF). To compare the consistency of preoperative paraspinal muscle FI evaluations using MRI and those via CT HUs in patients who underwent ACDF surgery. METHODS Ninety-five patients (45 males and 50 females, aged 37‒71 years) who received CT and MRI examinations and underwent ACDF surgery were retrospectively analyzed. In the axial T2-weighted MR images at the median level of the C3/4, C4/5, and C5/6 segments, regions of interests (ROIs) were delineated along the boundaries of the cervical multifidus (MF) and semispinalis cervicis (Scer) muscles. Using the threshold tool in ImageJ software, areas of fat tissue and intermuscular septa within the ROI were quantified. The effective cross-sectional area (ECSA) for each side was obtained by subtracting the areas of fat tissue and intermuscular septa from the total ROI area. The ratio of the fat tissue area to the CSA was then calculated to determine the initial FI value. The depth of subcutaneous fat from the midline spinous process to the epidermis at the median plane of the C4/5 intervertebral disc was measured. The initial FI values were then divided by the depth of fat to determine the post-correction FI value. Using the Picture Archiving and Communication System (PACS), at identical segments and planes, ROIs were delineated using the same method as in MRI under a standard soft tissue window (width of 500 HU, level of 60 HU). The CT HU values were measured within these defined areas. The CT HU values from both sides are summed to obtain the total HU value for the segment. According to whether the measurement results of two sets of data follow a normal distribution, Pearson's test or Sperman's test was used to analyze the correlation. RESULTS On MRI, a statistically significant difference was observed in the post-correction FI only at the C3/4 segment compared to the other two segments (P < 0.05). No significant difference in the post-correction FI between the C4/5 and C5/6 segments was noted (P > 0.05). The CT HU results showed a substantial discrepancy between C3/4 and C4/5 segments and between C3/4 and C5/6 segments (P < 0.05), whereas no statistically significant difference was found in the CT HU value between the C4/5 and C5/6 segments (P > 0.05). The consistency analysis revealed a relatively strong correlation between the post-correction FI and CT HU values of the C3/4 and C4/5 segments. Furthermore, a strong correlation was detected in the variations in the measurement outcomes at the C5/6 segment. CONCLUSION Patients requiring surgical treatment for the cervical spine exhibit varying degrees of FI in paraspinal muscles across different locations and segments. Evaluating the degree of FI in the paraspinal muscles of the cervical spine through CT HU values is feasible. There is considerable consistency between the post-correction FI assessed under MRI and the measurements of CT HU values in evaluating the FI of paraspinal muscles in the cervical spine.
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Affiliation(s)
- Yukun Ma
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Dingyan Zhao
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China.
| | - Xinliang Yue
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Letian Meng
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Luchun Xu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Ziye Qiu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Ningning Feng
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Guozheng Jiang
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, 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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Rummens S, Dierckx S, Brumagne S, Desloovere K, Peers K. Three-dimensional freehand ultrasonography to measure muscle volume of the lumbar multifidus: Reliability of processing technique and validity through comparison to magnetic resonance imaging. J Anat 2024; 244:601-609. [PMID: 38087647 PMCID: PMC10941570 DOI: 10.1111/joa.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024] Open
Abstract
There is a growing interest in muscle characteristics of the lumbar multifidus related to low back pain, but findings between studies are inconsistent. One of the issues explaining these conflicting findings might be the use of two-dimensional measures of cross-sectional area and thickness of the lumbar multifidus in most studies, which might be a suboptimal representation of the entire muscle volume. A three-dimensional volumetric assessment, combined with standardized imaging and processing measurement protocols, is highly recommended to quantify spinal muscle morphology. Three-dimensional freehand ultrasonography is a technique with large potential for daily clinical practice. It is achieved by combining conventional two-dimensional ultrasound with a motion-tracking system, recording the position and orientation of the ultrasound transducer during acquisition, resulting in a three-dimensional reconstruction. This study investigates intra- and interprocessor reliability for the quantification of muscle volume of the lumbar multifidus based on three-dimensional freehand ultrasound and its validity, in 31 patients with low back pain and 20 healthy subjects. Two processors manually segmented the lumbar multifidus on three-dimensional freehand ultrasound images using Stradwin software following a well-defined method. We assessed the concurrent validity of the measurement of multifidus muscle volume using three-dimensional freehand ultrasound compared with magnetic resonance imaging in 10 patients with low back pain. Processing reliability and agreement were determined using intraclass correlation coefficients, Bland-Altman plots, and calculation of the standard error of measurement and minimal detectable change, while validity was defined based on correlation analysis. The processing of three-dimensional freehand ultrasound images to measure lumbar multifidus volume was reliable. Good to excellent intraclass correlation coefficients were found for intraprocessor reliability. For interprocessor reliability, the intraclass correlation coefficients were moderate to good, emphasizing the importance of processing guidelines and training. A single processor analysis is preferred in clinical studies or when small differences in muscle volume are expected. The correlation between magnetic resonance imaging and three-dimensional freehand ultrasound measurements of lumbar multifidus volume was moderate to good but with a systematically smaller multifidus volume measured on three-dimensional freehand ultrasound. These results provide opportunities for both researchers and clinicians to reliably assess muscle structure using three-dimensional freehand ultrasound in patients with low back pain and to monitor changes related to pathology or interventions. To allow implementation in both research and clinical settings, guidelines on three-dimensional freehand ultrasound processing and training were provided.
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Affiliation(s)
- Sofie Rummens
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Dierckx
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Wang Z, Cao J, Mou J, Sun D, Yan D, Liu P. Effects of Cervical Paravertebral Extensors in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Grouped According to mK-Line. Orthop Surg 2024; 16:346-356. [PMID: 38097192 PMCID: PMC10834205 DOI: 10.1111/os.13964] [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: 07/17/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES The objective of this study was to quantify the morphology, composition, and asymmetry of the paravertebral extensor muscles (PSEMs) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) who had different modified K-line (mK-line) and the minimum interval between the mK-line and OPLL (INTmin ) values and to investigate the relationship between PSEMs and symptoms and outcomes following laminoplasty. These original findings elucidated that the atrophy of PSEMs could predict decompression outcomes and provided a theoretical basis for paraspinal muscle rehabilitation. METHODS A total of 94 consecutive patients who underwent laminoplasty for OPLL between January 2020 and January 2022 were enrolled in this retrospective study. The relative cross-sectional areas (rCSA), functional cross-sectional areas (rFCSA), and FCSA/CSA ratio of the multifidus (MF), semispinalis cervicalis (SSCe), semispinalis capitis (SSCa), and splenius capitis (SpCa) were measured at the C3-C7 segments on cervical magnetic resonance imaging (MRI). This study compared the differences between the mK-line (+) group and the mK-line (-) group, as well as between the INTmin <4 mm group and the INTmin ≥4 mm group, using the independent t-test or Mann-Whitney test for continuous variables and the χ2 -test for categorical variables. The correlations between the PSEMs and symptoms were analyzed using either the Pearson or Spearman correlation coefficient. RESULTS The relative total CSA (rTCSA) of the PSEMs, especially the MF, was significantly smaller in the mK-line (-) group. However, the FCSA/CSA of the right deep extensor muscle (DEM) was larger. The asymmetry of the MF TFCSA/TCSA showed a significant difference between the mK-line groups. In the INTmin <4 mm group, the PSEMs rCSA and rFCSA were significantly smaller, while the bilateral MF TFCSA/TCSA and right SSCe TFCSA/TCSA were larger. The asymmetry of the superficial extensor muscle rCSA was significantly lower in the group with INTmin <4 mm. The postoperative modified Japanese Orthopedic Association score (mJOA) and mJOA recovery rate were positively correlated with the INTmin and DEM rCSA and negatively correlated with the asymmetry of MF FCSA/CSA. CONCLUSIONS In patients with mK-line (-) or INTmin <4 mm, the PSEMs were smaller, and the DEM atrophy and composition changes were predominant. The MF asymmetry was higher in patients with mK-lines (-), whereas the SEM atrophy and asymmetry were more prevalent in patients with INTmin <4 mm. The DEM was related to the preoperative and postoperative mJOA scores. DEM-preserving surgery or DEM-specific rehabilitation exercises can improve the recovery of patients with OPLL during the perioperative period. In addition, attention should be paid to the evaluation of the SEM, especially the SpCa at the C3 and C5 levels.
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Affiliation(s)
- Zhao‐Lin Wang
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
| | - Jian Cao
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
| | - Jian‐Hui Mou
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
| | - Dong Sun
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
| | - Dong Yan
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
| | - Peng Liu
- Department of OrthopaedicsChina‐Japan Union Hospital of Jilin UniversityChangchunPR China
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Elliott JM, Wesselink EO, Crawford RJ, Cornwall J, McKay M, Smith Z, Weber KA. Artificial Intelligence in Spine and Paraspinal Muscle Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1462:465-473. [PMID: 39523283 DOI: 10.1007/978-3-031-64892-2_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Disorders affecting the neurological and musculoskeletal systems represent international health burdens. A significant impediment to progress with interventional trials is the absence of responsive, objective, and valid outcome measures sensitive to early disease or disorder change. A key finding in individuals with spinal disorders is compositional changes to the paraspinal muscle and soft tissue (e.g., intervertebral disc, facet joint capsule, and ligamentous) structure. Quantification of paraspinal muscle composition by MRI has emerged as a sensitive marker for the severity of these conditions; however, little is known about the composition of muscles across the lifespan. Knowledge of what is "typical" age-related muscle composition is essential in order to accurately identify and evaluate "atypical," with a potential impact being improvements in pre- and postsurgical plan and measurement of surgical implants, exoskeletons, and care on a patient-by-patient basis.
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Affiliation(s)
- James M Elliott
- Faculty of Medicine and Health, The University of Sydney, Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW, Australia.
| | - Evert O Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Marnee McKay
- Faculty of Medicine and Health, School of Health Sciences, Division of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
| | - Zachary Smith
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kenneth A Weber
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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9
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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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10
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Chen Q, Wang Z, Zhang S. Exploring the latest advancements in physical therapy techniques for treating cervical spondylosis patients: A narrative review. BIOMOLECULES & BIOMEDICINE 2023; 23:752-759. [PMID: 37212037 PMCID: PMC10494843 DOI: 10.17305/bb.2023.9049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
Cervical spondylosis is a widespread medical condition that significantly impacts patients' quality of life. Treatment options include surgical and conservative approaches, with conservative treatment often being the preferred choice. Rehabilitation therapy is an essential component of conservative treatment, and advancements in technology have the way to the development of new physiotherapy techniques. The effectiveness of treatment largely hinges on the patient's ability to improve their dysfunction. This study aims to provide valuable insights into the use of new physical therapy techniques, such as Sling Exercises Training (SET), fascia manipulation, muscle energy technique (MET), and proprioceptive neuromuscular facilitation (PNF), that aid the rehabilitation of cervical spondylosis. By scrutinizing the current research status of these techniques, this study aims to present innovative ideas enhancing the rehabilitation process and outcomes for patients suffering from cervical spondylosis.
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Affiliation(s)
- Quanzheng Chen
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Zhenshan Wang
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Shuna Zhang
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
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11
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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: 0.5] [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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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: 1.3] [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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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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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: 22] [Impact Index Per Article: 5.5] [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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