Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash?

Elliott, James M.; Parrish, Todd B.; Walton, David M.; Vassallo, Amy; Fundaun, Joel; Wasielewski, Marie; Courtney, D. Mark

doi:10.1016/j.ajem.2019.06.052

Cited by 9 publications

(9 citation statements)

References 55 publications

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“…It is proposed that such narrowing could compress the nerve roots and ganglia in the lower cervical spine, particularly in individuals with congenitally narrow foramen or those with pre-collision osteophytes. Recent evidence also provides foundation that the number of degenerative pathologies seen on initial post MVC computed tomography 19 , and pre-collision medical diagnoses 20 may be associated with the subsequent clinical course of whiplash, and this could align with our findings of significantly larger magnitudes of Q1 MFI, notably at C5, in the symptomatic participants at 12-months. Comparing quartile MFI to the number of degenerative pathologies at all cervical levels across injured male and female participants of varying age is warranted and underway.…”

Section: Discussionsupporting

confidence: 84%

“…It is important to also recognize these findings support previous preliminary cross-sectional work involving patients with varying levels of chronic WAD-related disability and healthy controls across two cultures (United States 1 and Sweden 7 ); where different insurance schemes and medical/rehabilitative options may influence recovery. While larger proportions of MFI in the multifidus muscles have been attributed to severe WAD, further prospective investigations, with larger sample sizes, are required to identify an element of pre-existing organic origins [19][20][21] , specific injury mechanisms underlying MFI 22,23 , biomechanical consequences [24][25][26][27][28] and their relationships to the further development of MFI with a long-term goal of informing clinical trials; exercise in particular 29 .…”

Section: Discussionmentioning

confidence: 99%

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Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Smith

Albin

Abbott

et al. 2020

Sci Rep

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Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixtyone participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1-Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD. Various investigations across three continents (United States 1-3 , Australia 2,4-6 , and Sweden 7,8) have used similar manual segmentation methods with magnetic resonance imaging (MRI) to demonstrate widespread fatty infiltrates in the neck muscles of individuals with acute and chronic whiplash associated disorders (WAD). Comparably high levels of muscle fat infiltration (MFI) were not identified in individuals who (i) had recovered or reported lower levels of WAD-related disability 1,3,4,7,8 , (2) had chronic non-traumatic neck pain 9 , or (3) those without a history of neck disorders 10. Knowledge of a precise mechanism for MFI expression and distribution (e.g. extra-or intra-fascicular MFI) would provide a target for clinical remediation of any adverse symptoms; but this is largely unknown. There remains conjecture in the literature about what constitutes extra-or intra-fascicular MFI, which likely centres on our ability to reliably distinguish the epimysium/perimysium and associated muscle fascicles on MRI. Some have proposed standardised, anatomical definitions of regions of interest in quantifying spinal muscle composition 11,12 , which we concede can be difficult for the cervical spine (eg transversospinal muscles like multifidus).

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Smith

Albin

Abbott

et al. 2020

Sci Rep

Self Cite

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“…Patients with severe WAD had significantly higher MFI in multifidi both in model B and model C, implying that self-reported disability and MFI are connected although the time since injury does not affect the result. One hypothesis is that a higher fat infiltration (or degenerative pathologies) prior the trauma might affect the recovery of the patient groups [32]. While it is largely unknown if and how changes in MFI is associated with poor functional recovery from whiplash, the results of this study support that higher amounts of MFI could contribute to predictive models towards determining whiplash recovery or other common conditions.…”

Section: Discussionmentioning

confidence: 51%

The relation between local and distal muscle fat infiltration in chronic whiplash using magnetic resonance imaging

et al. 2019

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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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“…Conventional medical imaging (radiographs, computed tomography (CT), and magnetic resonance imaging (MRI)) provides excellent visualization of the spinal anatomy and pathology. However, spinal conditions often present with multi-level pathological changes 5 , and incidental findings are frequently present even in asymptomatic individuals 6 , questioning the predictive value and clinical relevance of conventional imaging for long-term outcomes [7][8][9][10] . The recent application of artificial intelligence methods (e.g.…”

Section: Trmentioning

confidence: 99%

Multi-muscle deep learning segmentation to automate the quantification of muscle fat infiltration in cervical spine conditions

Weber

Abbott

Bojilov

et al. 2021

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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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Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash?

Cited by 9 publications

References 55 publications

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

The relation between local and distal muscle fat infiltration in chronic whiplash using magnetic resonance imaging

Multi-muscle deep learning segmentation to automate the quantification of muscle fat infiltration in cervical spine conditions

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