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Karlsson A, Peolsson A, Elliott J, Romu T, Ljunggren H, Borga M, Dahlqvist Leinhard O. The relation between local and distal muscle fat infiltration in chronic whiplash using magnetic resonance imaging. PLoS One 2019; 14:e0226037. [PMID: 31805136 PMCID: PMC6894804 DOI: 10.1371/journal.pone.0226037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/17/2019] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to investigate the relationship between fat infiltration in the cervical multifidi and fat infiltration measured in the lower extremities to move further into understanding the complex signs and symptoms arising from a whiplash trauma. Thirty-one individuals with chronic whiplash associated disorders, stratified into a mild/moderate group and a severe group, together with 31 age- and gender matched controls were enrolled in this study. Magnetic resonance imaging was used to acquire a 3D volume of the neck and of the whole-body. Cervical multifidi was used to represent muscles local to the whiplash trauma and all muscles below the hip joint, the lower extremities, were representing widespread muscles distal to the site of the trauma. The fat infiltration was determined by fat fraction in the segmented images. There was a linear correlation between local and distal muscle fat infiltration (p<0.001, r2 = 0.28). The correlation remained significant when adjusting for age and WAD group (p = 0.009) as well as when correcting for age, WAD group and BMI (p = 0.002). There was a correlation between local and distal muscle fat infiltration within the severe WAD group (p = 0.0016, r2 = 0.69) and in the healthy group (p = 0.022, r2 = 0.17) but not in the mild/moderate group (p = 0.29, r2 = 0.06). No significant differences (p = 0.11) in the lower extremities’ MFI between the different groups were found. The absence of differences between the groups in terms of lower extremities’ muscle fat infiltration indicates that, in this particular population, the whiplash trauma has a local effect on muscle fat infiltration rather than a generalized.
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Affiliation(s)
- Anette Karlsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Anneli Peolsson
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - James Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Thobias Romu
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Helena Ljunggren
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Magnus Borga
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Duration of symptoms in the quantification of upper limb disability and impairment for individuals with mild degenerative cervical myelopathy (DCM). PLoS One 2019; 14:e0222134. [PMID: 31498813 PMCID: PMC6733515 DOI: 10.1371/journal.pone.0222134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyper-reflexia, focal weakness, and sensory impairment. DCM can cause progressive loss of manual dexterity, reduced upper limb (UL) function and disability. The purpose of this study was to define relationships between impairment and disability of the UL and determine the impact of duration of symptoms on disease severity. Design An observational cross-sectional study quantifying disease severity, UL impairment and disability at time of diagnosis was conducted. A second observational longitudinal cohort was studied at the time of diagnosis and 1 year later. Setting Toronto Western Hospital, Spine Program. Subjects The cross sectional study included 140 study subjects diagnosed with mild, moderate or severe DCM. For the longitudinal study, 61 study subjects with mild DCM were enrolled and split into two groups, one group with less than 12 months of symptom duration and more than 12 months. Main measures Modified Japanese Orthopaedic Assessment (mJOA); Graded Redefined Assessment of Sensation, Strength and Prehension (GRASSP); Quick Disability of the Arm, Shoulder and Hand (QuickDASH). Results Pearson correlation coefficients between GRASSP and QuickDASH revealed significant relationships between strength, sensation and dexterity for all patients to varying degrees. The covariate (mJOA) was significantly related to QuickDASH, indicating duration of symptoms has an important effect on UL disability in the mild severity group. Conclusions Strength, sensation and dexterity play a defining role in disability of the UL across all severities of DCM and are discriminant measures. Duration of symptoms has a significant impact on self-perceived disability, where a longer duration in mild patients results in diminished disability, suggesting adaptation. Duration of symptoms is an important factor to consider in the treatment plan for patients with mild disease.
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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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Smith AC, Weber KA, O'Dell DR, Parrish TB, Wasielewski M, Elliott JM. Lateral Corticospinal Tract Damage Correlates With Motor Output in Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:660-666. [PMID: 29107041 DOI: 10.1016/j.apmr.2017.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the relationship between spinal cord damage and specific motor function in participants with incomplete spinal cord injury (iSCI). DESIGN Single-blinded, cross-sectional study design. SETTING University setting research laboratory. PARTICIPANTS Individuals with chronic cervical iSCI (N=14; 1 woman, 13 men; average age ± SD, 43±12y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Axial T2-weighted magnetic resonance imaging (MRI) of spinal cord damage was performed in 14 participants with iSCI. Each participant's damage was processed for total damage quantification, lateral corticospinal tract (LCST) and gracile fasciculus (GF) analysis. Plantarflexion and knee extension were quantified using an isokinetic dynamometer. Walking ability was assessed using a 6-minute walk test. RESULTS Total damage was correlated with plantarflexion, knee extension, and distance walked in 6 minutes. Right LCST damage was correlated with right plantarflexion and right knee extension, while left LCST damage was correlated with left-sided measures. Right and left GF damage was not correlated with the motor output measures. CONCLUSIONS MRI measures of spinal cord damage were correlated to motor function, and this measure appears to have spatial specificity to descending tracts, which may offer prognostic value after SCI.
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Affiliation(s)
- Andrew C Smith
- Regis University School of Physical Therapy, Denver, CO; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL.
| | - Kenneth A Weber
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA
| | | | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL
| | - Marie Wasielewski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
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Grabher P, Mohammadi S, David G, Freund P. Neurodegeneration in the Spinal Ventral Horn Prior to Motor Impairment in Cervical Spondylotic Myelopathy. J Neurotrauma 2017; 34:2329-2334. [PMID: 28462691 DOI: 10.1089/neu.2017.4980] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Remote gray matter pathology has been suggested rostral to the compression site in cervical spondylotic myelopathy (CSM). We therefore assessed neurodegeneration in the gray matter ventral and dorsal horns. Twenty patients with CSM and 18 healthy subjects underwent a high-resolution structural and diffusion magnetic resonance imaging protocol at vertebra C2/C3. Patients received comprehensive clinical assessments. T2*-weighted data provided cross-sectional area measurements of gray matter ventral and dorsal horns to identify atrophy. At the identical location, mean diffusivity (MD) and fractional anisotropy (FA) determined the microstructural integrity. Finally, the relationships between neurodegeneration occurring in the gray and white matter and clinical impairment were investigated. Patients suffered from mild-to-moderate CSM with mainly sensory impairment. In the ventral horns, cross-sectional area was not reduced (p = 0.863) but MD was increased (p = 0.045). The magnitude of MD changes within the ventral horn was associated with white matter diffusivity changes (MD: p = 0.013; FA: p = 0.028) within the lateral corticospinal tract. In contrast, dorsal horn cross-sectional area was reduced by 16.0% (p < 0.001) without alterations in diffusivity indices, compared with controls. No associations between the magnitude of ventral and dorsal horn neurodegeneration and clinical impairment were evident. Focal cord gray matter pathology is evident remote to the compression site in vivo in CSM patients. Microstructural changes in the ventral horns (i.e., motoneurons) related to corticospinal tract integrity in the absence of atrophy and marked motor impairment. Dorsal horn atrophy corresponded to main clinical representation of sensory impairment. Thus, neuroimaging biomarkers of cord gray matter integrity reveal focal neurodegeneration prior to marked clinical impairment and thus could serve as predictors of ensuing impairment in CSM patients.
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Affiliation(s)
- Patrick Grabher
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Siawoosh Mohammadi
- 2 Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf , Hamburg, Germany .,3 Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London , London, United Kingdom .,4 Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
| | - Gergely David
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Patrick Freund
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland .,3 Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London , London, United Kingdom .,4 Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany .,5 Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London , London, United Kingdom
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