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Webb AL, Lynch JT, Pickering MR, Perriman DM. Shape modelling of the oropharynx distinguishes associations with body morphology but not whiplash-associated disorder. J Anat 2022; 242:535-543. [PMID: 36300770 PMCID: PMC9919469 DOI: 10.1111/joa.13783] [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: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Characterization of the oropharynx, a subdivision of the pharynx between the soft palate and the epiglottis, is limited to simple measurements. Structural changes in the oropharynx in whiplash-associated disorder (WAD) cohorts have been quantified using two-dimensional (2D) and three-dimensional (3D) measures but the results are inconsistent. Statistical shape modelling (SSM) may be a more useful tool for systematically comparing morphometric features between cohorts. This technique has been used to quantify the variability in boney and soft tissue structures, but has not been used to examine a hollow cavity such as the oropharynx. The primary aim of this project was to examine the utility of SSM for comparing the oropharynx between WAD cohorts and control; and WAD severity cohorts. The secondary aim was to determine whether shape is associated with sex, height, weight and neck length. Magnetic resonance (MR) T1-weighted images were obtained from healthy control (n = 20), acute WAD (n = 14) and chronic WAD (n = 14) participants aged 18-39 years. Demographic, WAD severity (neck disability index) and body morphometry data were collected from each participant. Manual segmentation of the oropharynx was undertaken by blinded researchers between the top of the soft palate and tip of the epiglottis. Digital 3D oropharynx models were constructed from the segmented images and principal component (PC) analysis was performed with the PC weights normalized to z-scores for consistency. Statistical analyses were undertaken using multivariate linear models. In the first statistical model the independent variable was group (acute WAD, chronic WAD, control); and in the second model the independent variable was WAD severity (recovered/mild, moderate/severe). The covariates for both models included height, weight, average neck length and sex. Shape models were constructed to visualize the effect of perturbing these covariates for each relevant mode. The shape model revealed five modes which explained 90% of the variance: mode 1 explained 59% of the variance and primarily described differences in isometric size of the oropharynx, including elongation; mode 2 (13%) primarily described lateral (width) and AP (depth) dimensions; mode 3 (8%) described retroglossal AP dimension; mode 4 (6%) described lateral dimensions at the retropalatal-retroglossal junction and mode 5 (4%) described the lateral dimension at the inferior retroglossal region. There was no difference in shape (mode 1 p = 0.52; mode 2 p = 0.96; mode 3 p = 0.07; mode 4 p = 0.54; mode 5 p = 0.74) between control, acute WAD and chronic WAD groups. There were no statistical differences for any mode (mode 1 p = 0.12; mode 2 p = 0.29; mode 3 p = 0.56; mode 4 p = 0.99; mode 5 p = 0.96) between recovered/mild and moderate/severe WAD. Sex was not significant in any of the models but for mode 1 there was a significant association with height (p = 0.007), mode 2 neck length (p = 0.044) and in mode 3 weight (p = 0.027). Although SSM did not detect differences between WAD cohorts, it did detect associations with body morphology indicating that it may be a useful tool for examining differences in the oropharynx.
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Affiliation(s)
- Alexandra L. Webb
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia
| | - Joseph T. Lynch
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia,Trauma and Orthopaedic Research Unit, Canberra Health ServicesCanberra, ACTAustralia
| | - Mark R. Pickering
- School of Engineering and Information TechnologyUniversity of New South WalesCanberra, ACTAustralia
| | - Diana M. Perriman
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia,Trauma and Orthopaedic Research Unit, Canberra Health ServicesCanberra, ACTAustralia
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Stone D, Ward EC, Bogaardt H, Heard R, Martin-Harris B, Smith AC, Elliott JM. Self-reported Dysphagia and Pharyngeal Volume Following Whiplash Injury. Dysphagia 2021; 36:1019-1030. [PMID: 33386482 DOI: 10.1007/s00455-020-10233-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
Difficulty swallowing has been reported following whiplash injury; however, the reasons remain poorly understood. A possible factor may be the observed changes in pharyngeal volume. The current exploratory study was designed to examine the prevalence of self-reported dysphagia after whiplash and the relationship with recovery status and change in pharyngeal volume. Data were available from a longitudinal study of adults with whiplash. Data included magnetic resonance imaging (MRI) of the cervical spine, the Dysphagia Handicap Index (DHI), and Neck Disability Index (NDI) collected over four timepoints (< 1 week, 2 weeks, 3 months, and 12 months post-injury). Initial cross-sectional analysis examined 60 patients with DHI data from at least one timepoint. A second, longitudinal analysis was conducted on 31 participants with MRI, NDI, and DHI data at both early (< 1-2 weeks) and late (3-12 months) timepoints. The pharynx was contoured on axial T2-weighted MRI slices using OsiriX image processing software and pharyngeal volume (mm3) was quantified. In the 60-patient cohort, prevalence of self-reported dysphagia (DHI ≥ 3) was observed in 50% of participants at least once in 12 months (M = 4.9, SD 8.16, range 0-40). In the longitudinal cohort (n = 31), mean total DHI significantly (p = 0.006) increased between early and late stages. There was no relationship (p = 1.0) between dysphagia and recovery status, per the NDI% score. Pharyngeal volume remained stable and there was no relationship between dysphagia and pharyngeal volume change (p = 1.0). This exploratory study supports the need for further work to understand the nature of dysphagia, extent of functional compromise, and the underlying pathophysiology post-whiplash.
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Affiliation(s)
- D Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
- Speech Pathology Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.
| | - E C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - H Bogaardt
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - R Heard
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - B Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A C Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - J M Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Stone DB, Ward EC, Knijnik SR, Bogaardt H, Elliott JM. Whiplash-Associated Dysphagia and Dysphonia: A Scoping Review. Dysphagia 2020; 36:303-315. [PMID: 32445061 DOI: 10.1007/s00455-020-10137-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/15/2020] [Indexed: 01/23/2023]
Abstract
Swallowing and voice complaints after a whiplash injury have been observed and reported in several studies; however, variability in study design complicates current understanding of whether dysphagia and dysphonia should be recognised as potential adverse outcomes. A scoping review was conducted across six databases from 1950 to March 2019. A total of 18 studies were included for review. Data regarding study purpose, design, outcome measures, participant characteristics and outcomes reported were extracted. Level of evidence (LOE) was assessed by the American Speech-Language Language Association (ASHA)'s LOE system. All studies were exploratory, with 68% rated as poor (< 3) on quality ratings. Nearly half (n = 6) were single case reports. Only three studies investigated some type of swallow-related outcome specifically within the study aim/s. Incidence of swallow-related problems ranged from 2 to 29%, with unspecified complaints of "swallowing difficulty", "dysphagia" and fatigue and pain whilst chewing reported. Neither swallowing biomechanics nor the underlying pathophysiology of swallow or voice complaints was investigated in any study. Four case studies presented post-whiplash voice complaints; two of which described loss of pitch range. Others described hoarseness, loss of control and weak phonation. Most studies only mentioned swallow- or voice-related deficits when reporting a wider set of post-injury symptomatology and six did not describe the outcome measure used to identify the swallow and voice-related problems reported. The existing literature is limited and of low quality, contributing to an unclear picture of the true incidence and underlying mechanisms of whiplash-related dysphagia and dysphonia.
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Affiliation(s)
- D B Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia. .,Speech Pathology Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia. .,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.
| | - E C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - S R Knijnik
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,The Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - H Bogaardt
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - J M Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Snodgrass SJ, de Zoete RMJ, Croker C, Yerrapothu M, Elliott JM. Reliability of cervical muscle volume quantification using magnetic resonance imaging. Musculoskelet Sci Pract 2019; 44:102056. [PMID: 31563630 DOI: 10.1016/j.msksp.2019.102056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/06/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is used to quantify the size and structure of the architecturally complex cervical spine musculature of individuals with traumatic and idiopathic neck pain. However, to our knowledge, no scan-rescan reliability data is available on neck muscle volumes. OBJECTIVES This study investigates the intra- and inter-rater reliability and scan-rescan reliability in cervical muscle volume investigations. DESIGN Clinical Measurement, Reliability study. METHODS MRI scans were performed and repeated (within 1 h) for five asymptomatic individuals. Two raters manually traced levator scapulae, multifidus including semispinalis cervicis, semispinalis capitis, splenius capitis including splenius cervicis, and sternocleidomastoid using Analyze software (v12.0). Reliability was determined using intra-class correlation coefficients, Lin's concordance coefficient and Bland-Altman plots, with interpretation of reliability coefficients using the criteria from Fleiss. RESULTS Intra-rater reliability of muscle quantification was excellent (ICCs ranging from 0.78 to 0.96). Inter-rater reliability was excellent for sternocleidomastoid(ICC 0.92, 95% CI 0.80, 0.97) and splenius capitis (ICC 0.77, 0.51, 0.90), and ranged from fair to good for levator scapulae (0.63, 0.18, 0.85), multifidus (0.73, 0.44, 0.88), and semispinalis capitis (0.50, 0.08, 0.77). The scan-rescan reliability was excellent for all muscles (ICCs ranging from 0.94 to 0.98). CONCLUSION Threats to reliability appear to be more related to manual quantification of muscles on images rather than protocols related to re-positioning a participant in the scanner and repeating the same protocol. The current findings suggest that the proposed methods can be used in establishing normative data for cervical muscle volume and comparing individuals with and without neck pain.
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Affiliation(s)
- Suzanne J Snodgrass
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Rutger M J de Zoete
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia.
| | - Christopher Croker
- Faculty of Health and Medicine, The University of Newcastle, Australia; Centre for Brain and Mental Health Research, The University of Newcastle, Australia.
| | - Meghana Yerrapothu
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA.
| | - James M Elliott
- Neuromuscular Imaging Research Laboratory, Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, USA; Northern Sydney Local Health District, The Kolling Institute, and Faculty of Health Sciences, The University of Sydney, Australia.
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[Dysphagia in cervical spine diseases]. HNO 2019; 67:801-814. [PMID: 31485696 DOI: 10.1007/s00106-019-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dysphagia is a common symptom and can be indicative of a variety of heterogeneous diseases. "Classical" diseases of the head and neck region, such as acute tonsillitis, peritonsillar abscesses, diverticula, and benign or malignant tumors are common causes of dysphagia. However, it can also occur in the context of neurological diseases, e.g., as a result of stroke or as an age-related phenomenon (presbyphagia). Pathologies of the cervical spine can also be a cause of dysphagia. In this context, congenital or acquired diseases, inflammatory or degenerative processes, cervical spine surgery, and (malignant) masses of the cervical spine should be taken into account. Particular dysphagia with a positive history of previous operative interventions on the cervical spine or symptoms such as chronic back pain and trauma should give rise to consideration of a cervical spine-related cause.
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Stone D, Bogaardt H, Linnstaedt SD, Martin-Harris B, Smith AC, Walton DM, Ward E, Elliott JM. Whiplash-Associated Dysphagia: Considerations of Potential Incidence and Mechanisms. Dysphagia 2019; 35:403-413. [PMID: 31377863 DOI: 10.1007/s00455-019-10039-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/09/2019] [Accepted: 07/20/2019] [Indexed: 12/14/2022]
Abstract
Non-specific self-reports of dysphagia have been described in people with whiplash-associated disorders (WAD) following motor vehicle collision (MVC); however, incidence and mechanistic drivers remain poorly understood. Alterations in oropharyngeal dimensions on magnetic resonance imaging (MRI), along with heightened levels of stress, pain, and changes in stress-dependent microRNA expression (e.g., miR-320a) have been also associated with WAD, suggesting multi-factorial issues may underpin any potential swallowing changes. In this exploratory paper, we examine key biopsychosocial parameters in three patients with persistent WAD reporting swallowing change and three nominating full recovery after whiplash with no reported swallowing change. Parameters included (1) oropharyngeal volume with 3D MRI, (2) peritraumatic miR-320a expression, and (3) psychological distress. These factors were explored to highlight the complexity of patient presentation and propose future considerations in relation to a potential deglutition disorder following WAD. The three participants reporting changes in swallowing all had smaller oropharyngeal volumes at < 1 week and at 3 months post injury and lower levels of peritraumatic miR-320a. At 3 months post MVC, oropharyngeal volumes between groups indicated a large effect size (Hedge's g = 0.96). Higher levels of distress were reported at both time points for those with persistent symptomatology, including self-reported dysphagia, however, this was not featured in those nominating recovery. This paper considers current evidence for dysphagia as a potentially under-recognized feature of WAD and highlights the need for future, larger-scaled, multidimensional investigation into the incidence and mechanisms of whiplash-associated dysphagia.
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Affiliation(s)
- D Stone
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.
- Speech Pathology Department, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - H Bogaardt
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - S D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - D M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - E Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - J M Elliott
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
- Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Elliott JM, Cornwall J, Kennedy E, Abbott R, Crawford RJ. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskelet Disord 2018; 19:171. [PMID: 29807530 PMCID: PMC5972401 DOI: 10.1186/s12891-018-2074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.
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Affiliation(s)
- James M Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Australia 75 East Street Lidcombe NSW, Sydney, 2141, Australia. .,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Honorary Fellow School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Hill L, Aboud D, Elliott J, Magnussen J, Sterling M, Steffens D, Hancock MJ. Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review. Spine J 2018; 18:880-891. [PMID: 29412188 DOI: 10.1016/j.spinee.2018.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear. PURPOSE We aimed to investigate whether findings on cervical spine MRI predict future neck pain. STUDY DESIGN A systematic review was carried out. PATIENT SAMPLE People with or without neck pain comprised the study sample. OUTCOME MEASURES Clinically important neck pain outcomes such as pain and disability. METHODS The review protocol was registered on PROSPERO [CRD42016049228]. MEDLINE, CINAHL, and EMBASE databases were searched. Prospective cohort studies investigating the association between baseline MRI findings and clinical outcome were included. Cohorts with serious underlying diseases as the cause of their neck pain were excluded. Associations between MRI findings and neck pain outcomes were extracted from the included studies. RESULTS A total of 12 studies met all inclusion criteria. Eight studies presented data on participants with current neck pain, two studies included a mixed sample, and two studies included a sample of participants with no current neck pain. Because of the heterogeneity between the studies in terms of MRI findings, populations, and clinical outcomes investigated, it was not possible to pool the results. No consistent associations between MRI findings and future outcomes were identified. Single studies of populations with neck pain reported significant associations for neck muscle fatty infiltrate (risk ratio [RR]: 21.00, 95% confidence interval [CI]: 2.97-148.31) with persistent neck disability; disc protrusion (mean difference ranged from -1.83 to -2.88 on a 10-point pain scale), and disc degeneration (RR: 0.59; 95% CI: 0.36-0.98) with neck pain. In a population without pain, the development of foraminal stenosis over a 10-year period was associated with development of neck pain (RR: 2.99; 95% CI: 1.23-7.23). CONCLUSION The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain.
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Affiliation(s)
- Laura Hill
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - David Aboud
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - James Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Sydney, 2065, Australia; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Magnussen
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia
| | - Michele Sterling
- Recover Injury Research Centre and Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, QLD 4072, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney Medical School, The Univeristy of Sydney, Sydney, NSW 2050, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Balaclava Rd, North Ryde, Sydney 2109, Australia.
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Shawky A, Elnady B, El-Morshidy E, Gad W, Ezzati A. Longus colli tendinitis. A review of literature and case series. SICOT J 2017; 3:48. [PMID: 28664844 PMCID: PMC5492790 DOI: 10.1051/sicotj/2017032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/09/2017] [Indexed: 12/05/2022] Open
Abstract
Purpose: To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented. Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized. Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years. Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.
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Affiliation(s)
- Ahmed Shawky
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt - Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany
| | - Belal Elnady
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Essam El-Morshidy
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Wael Gad
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Ali Ezzati
- Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany
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Elliott JM, Dayanidhi S, Hazle C, Hoggarth MA, McPherson J, Sparks CL, Weber KA. Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash? J Orthop Sports Phys Ther 2016; 46:862-873. [PMID: 27690836 PMCID: PMC7274526 DOI: 10.2519/jospt.2016.6735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates. For many of the probable pathoanatomical lesions (eg, fracture, ligamentous rupture, disc injury), there remains a lack of available clinical tests for identifying their presence. Fractures, particularly at the craniovertebral and cervicothoracic junctions, may be radiographically occult. While high-resolution computed tomography scans can detect fractures, there remains a lack of prevalence data for fractures in this population. Conventional magnetic resonance imaging has not consistently revealed lesions in patients with acute or chronic whiplash, a "failure" that may be due to limitations in the resolution of available devices and the use of standard sequences. The technological evolution of imaging techniques and sequences eventually might provide greater resolution to reveal currently elusive anatomical lesions (or, perhaps more importantly, temporal changes in physiological responses to assumed lesions) in those patients at risk of poor recovery. Preliminary findings from 2 prospective cohort studies in 2 different countries suggest that this is so, as evidenced by changes to the structure of skeletal muscles in those who do not fully recover. In this clinical commentary, we will briefly introduce the available imaging decision rules and the current knowledge underlying the pathomechanics and pathophysiology of whiplash. We will then acknowledge known prognostic factors underlying functional recovery. Last, we will highlight emerging evidence regarding the pathobiology of muscle degeneration/regeneration, as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, functional magnetic resonance imaging, magnetization transfer imaging, spectroscopy, diffusion-weighted imaging) that may be used as noninvasive and objective complements to known prognostic factors associated with whiplash recovery, in particular, poor functional recovery. J Orthop Sports Phys Ther 2016;46(10):861-872. doi:10.2519/jospt.2016.6735.
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Au J, Perriman DM, Pickering MR, Buirski G, Smith PN, Webb AL. Magnetic resonance imaging atlas of the cervical spine musculature. Clin Anat 2016; 29:643-59. [PMID: 27106787 DOI: 10.1002/ca.22731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/12/2016] [Accepted: 04/20/2016] [Indexed: 11/10/2022]
Abstract
The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- John Au
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Mark R Pickering
- School of Engineering and Information Technology, Australian Defence Force Academy, University of New South Wales, Canberra, Australia
| | - Graham Buirski
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.,MusculoSkeletal Imaging, Sidra Medical and Research Center, Doha, Qatar
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.,Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Alexandra L Webb
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
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