title: The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration.
abstract: METHODS
  Single-center prospective longitudinal study.
  
  
  OBJECTIVE
  To study the (1) temporal development of muscle fatty infiltrates (MFI) in the cervical multifidi after whiplash, (2) differences in multifidi MFI between those who recover or report milder pain-related disability and those who report moderate/severe symptoms at 3 months, and (3) predictive value of multifidi MFI outcomes.
  
  
  BACKGROUND
  The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. The replication of such findings has yet to be explored longitudinally.
  
  
  METHODS
  Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%-28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury. The effects of time and group (per Neck Disability Index) and the interaction of time by group on MFI were determined. Receiver operating characteristic curve analysis was used to determine a cut-point for MFI at 2 weeks to predict outcome at 3 months.
  
  
  RESULTS
  There was no difference in MFI across groups at enrolment. MFI values were significantly higher in the severe group than those in the recovered/mild group at 2 weeks and 3 months. The receiver operating characteristic curve analysis indicated that MFI levels of 20.5% or above resulted in a sensitivity of 87.5% and a specificity of 92.9% for predicting outcome at 3 months.
  
  
  CONCLUSIONS
  Consistent with previous evidence, muscle degeneration occurs soon after injury but only in those patients with poor functional recovery. This study provides further evidence that (1) multifidi MFI occur in tandem with known predictive risk factors (older age, pain-related disability, and post-traumatic stress disorder) and (2) routine imaging protocols may need to be reconsidered in the vast majority of patients after whiplash.
  
  
  METHODS
  3.
authors.affiliation: *Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL †School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia ‡Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL §Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL ¶Centre for National Research on Disability and Rehabilitation Medicine (CONROD), Griffith Health Institute, Griffith University, Parklands QLD, Australia ‖Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia **Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and ††Department of Biomedical Engineering, Northwestern University, Evanston, IL.
authors.forename: James M
authors.initials: JM
authors.lastname: Elliott
authors.forename: D Mark
authors.initials: DM
authors.lastname: Courtney
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Daniel
authors.initials: D
authors.lastname: Pinto
authors.forename: Michele M
authors.initials: MM
authors.lastname: Sterling
authors.forename: Todd B
authors.initials: TB
authors.lastname: Parrish
mesh_terms: D000273:Adipose Tissue / Q000473:pathology* / Q000503:physiopathology; D000328:Adult; D019540:Area Under Curve; D002574:Cervical Vertebrae; D002641:Chicago; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000473:pathology* / Q000503:physiopathology; D010147:Pain Measurement; D064170:Paraspinal Muscles / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D014911:Whiplash Injuries / Q000473:pathology* / Q000503:physiopathology; D055815:Young Adult