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Farrell SF, Cornwall J, Osmotherly PG. Magnetic Resonance Imaging Investigation of Cervical-Spine Meniscoid Composition: A Validation Study. J Manipulative Physiol Ther 2020; 43:579-587. [PMID: 32861523 DOI: 10.1016/j.jmpt.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/30/2019] [Accepted: 10/10/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The composition of cervical-spine meniscoids may have clinical significance in neck-pain conditions, but the accuracy of assessment of meniscoid composition in vivo using magnetic resonance imaging has not been established. The aim of this study was to compare cervical-spine meniscoid composition by magnetic resonance imaging with histologic composition. METHODS Four embalmed cadaveric cervical spines (mean [standard deviation] age, 79.5 [3.7] years; 1 female, 3 male) underwent magnetic resonance imaging, allowing radiologic classification of lateral atlantoaxial- and zygapophyseal-joint (C2-3 to C6-7) meniscoids as either mostly fatty, mixed tissue, or mostly connective tissue. Subsequently, each joint was dissected and disarticulated to allow excision of meniscoids for histologic processing. Each meniscoid was sectioned sagittally, stained with hematoxylin and eosin, examined using light microscopy, and classified as adipose, fibroadipose, or fibrous in composition. Data were analyzed using the kappa statistic with linear weighting. RESULTS From dissection, 62 meniscoids were identified, excised, and processed; 46 of these 62 were visualized with magnetic resonance imaging. For single-rater identifying structures, agreement between assessment of meniscoid composition by magnetic resonance imaging and by microscopy was fair (κ = 0.24; 95% confidence interval, 0.02-0.46; P = .02). CONCLUSION Findings suggest that the accuracy of this method of magnetic resonance imaging assessment of cervical-spine meniscoid composition may be limited. This should be considered when planning or interpreting research investigating meniscoid composition using magnetic resonance imaging.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, National Health and Medical Research Council Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Jon Cornwall
- Otago Medical School, University of Otago, Dunedin, New Zealand; Institute for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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Farrell SF, Smith AD, Hancock MJ, Webb AL, Sterling M. Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 49:1638-1654. [DOI: 10.1002/jmri.26567] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Scott F. Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
| | - Ashley D. Smith
- School of Allied Health Sciences Griffith University Gold Coast Australia
| | - Mark J. Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Alexandra L. Webb
- Medical School, College of Health and Medicine Australian National University Canberra Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
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Farrell SF, Stanwell P, Cornwall J, Osmotherly PG. Quantitative magnetic resonance imaging assessment of lateral atlantoaxial joint meniscoid composition: a validation study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1180-1187. [PMID: 30604294 DOI: 10.1007/s00586-018-05868-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Lateral atlantoaxial (LAA) joint meniscoid composition may have clinical significance in patients following neck trauma. However, the existing method of radiologically assessing meniscoid composition has an inherent element of subjectivity, which could contribute to measurement variability. The present study sought to investigate the accuracy of two-point Dixon fat/water separation MRI as a quantitative assessment of LAA joint meniscoid composition. METHODS Sixteen LAA joint meniscoids were excised from four cadavers (mean [SD] age 79.5 [3.7] years; one female) following cervical spine MRI (two-point Dixon, T1-weighted VIBE and T2-weighted SPACE sequences). Composition of LAA joint meniscoids was undertaken by (1) histological examination by light microscopy, (2) calculation of fat fraction by Dixon MRI (both in-phase/opposed-phase and fat/water methods), and (3) the existing method of considering VIBE and SPACE signal intensities. Analysis was performed using the kappa statistic with linear weighting. RESULTS Microscopy revealed three, five, and eight meniscoids to be composed of adipose, fibroadipose, and fibrous tissues, respectively. Dixon sequence MRI classified 11 of these meniscoids correctly, with 'substantial' level of agreement (In-phase/Opp-phase kappa statistic = 0.78 [95% CI 0.38, 1.17]; fat/water kappa statistic = 0.72 [95% CI 0.32, 1.11]). Level of agreement between microscopy and the VIBE and SPACE method was 'slight' (kappa statistic = 0.02 [95% CI - 0.34, 0.38]). CONCLUSIONS Findings suggest that Dixon fat/water separation MRI may have superior utility in the assessment of LAA joint meniscoid composition than the existing method of considering VIBE and SPACE signal intensities. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. .,RECOVER Injury Research Centre, Level 7 Oral Health Building, The University of Queensland, Herston Campus, Herston, 4006, QLD, Australia.
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,Institute for Health Sciences, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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Elliott JM, Hancock MJ, Crawford RJ, Smith AC, Walton DM. Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury. Spine J 2018; 18:1489-1497. [PMID: 28774580 PMCID: PMC6874915 DOI: 10.1016/j.spinee.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings. PURPOSE This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes. STUDY DESIGN/SETTING A non-systematic review of the literature is carried out. METHODS A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided. RESULTS An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain. CONCLUSIONS Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.
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Affiliation(s)
- James M. Elliott
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite
1100, Chicago, IL, USA,School of Health and Rehabilitation Sciences, The
University of Queensland, Australia,The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District; The Kolling Institute, St. Leonards, NSW, Australia,Corresponding author. Department of Physical
Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern
University, 645 N. Michigan Ave, Suite 1100, Chicago, IL 60611, USA. Tel.:
(0011) 1-312-503-2304. (J.M.
Elliott)
| | - Mark J. Hancock
- Faculty of Medicine and Health Sciences, Macquarie
University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia
| | - Rebecca J. Crawford
- Zürich University of Applied Sciences,
Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Andrew C. Smith
- Regis University School of Physical Therapy, 3333 Regis
Boulevard, Denver, CO 80221, USA
| | - David M. Walton
- School of Physical Therapy, Western University, Room 1588,
London, Ontario N6G 1H1, Canada
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Farrell SF, Khan S, Osmotherly PG, Sterling M, Cornwall J, Rivett DA. Lateral atlantoaxial joint meniscoid volume in individuals with whiplash associated disorder: A case-control study. Musculoskelet Sci Pract 2018; 33:46-52. [PMID: 29153925 DOI: 10.1016/j.msksp.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic whiplash associated disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. OBJECTIVES This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain. DESIGN Case-control study. METHOD Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α < 0.05). RESULTS Ventral and dorsal meniscoids (n = 112) were found in each LAA joint. Greater dorsal meniscoid volume as a percentage of articular cavity volume was associated with higher pain intensity (odds ratio 1.48, p = 0.03; likelihood ratio test chi-square2 = 6.64, p = 0.04), however no significant differences existed between meniscoid volumes of WAD and control participants. CONCLUSIONS Findings indicate a potential link between dorsal LAA joint meniscoid volume and pain, suggesting larger meniscoid size may have pathoanatomical significance in WAD.
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Affiliation(s)
- Scott F Farrell
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia.
| | - Subaat Khan
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia; School of Medical Science, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia
| | - Peter G Osmotherly
- Discipline of Physiotherapy, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia
| | - Jon Cornwall
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, 6021, New Zealand; Department of Physiology, University of Otago, 270 Great King St, Dunedin, 9016, New Zealand; Institute for Health Sciences, Zurich University of Applied Science, Technikumstrasse 71, 8401, Winterthur, Zurich, Switzerland
| | - Darren A Rivett
- Discipline of Physiotherapy, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
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Abstract
A previous special issue of JOSPT (October 2016) discussed whiplash in terms of the clinical problems and current research surrounding prevention, biomechanics of injury, emergent care, imaging advancements, recovery pathways and prognosis, pathogenesis of posttrauma pain, acute and chronic management, and new predictive clinical tools. While great strides have been made in the field of whiplash and are continuing in earnest, a key group of clinicians and academics have recognized that inconsistent outcomes in published literature hamper our ability to meaningfully synthesize research findings, leading to results of systematic reviews that provide very few concrete clinical recommendations. We are optimistic that improved outcomes for people with whiplash-associated disorder (WAD) are attainable in the near future, as interdisciplinary research efforts continue to align internationally, new mechanisms are identified and explored, and advanced statistical techniques allow complex questions to be answered in clinically meaningful ways. J Orthop Sports Phys Ther 2017;47(7):444-446. doi:10.2519/jospt.2017.0106.
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Farrell SF, Osmotherly PG, Cornwall J, Sterling M, Rivett DA. Cervical spine meniscoids: an update on their morphological characteristics and potential clinical significance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:939-947. [DOI: 10.1007/s00586-016-4915-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 12/04/2016] [Indexed: 12/18/2022]
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Abstract
There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.
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