Original ArticleValidity and reliability of ultrasonography for the longus colli in asymptomatic subjects☆
Introduction
In recent years evidence has accumulated of impairment in deep cervical flexor muscle (DCF) function in neck pain sufferers (Falla et al., 2004a, Falla et al., 2004b, Falla, 2004, Jull et al., 2004, O'leary et al., 2007b). Evidence suggests that these muscles are important for the control and support of the cervical lordosis and maintenance of cervical spine postural form (Mayoux-Benhamou et al., 1994, Conley et al., 1995, Vasavada et al., 1998, Boyd-Clark et al., 2001, Boyd-Clark et al., 2002).
Furthermore, specific therapeutic retraining of the DCF muscles has demonstrated efficacy in the management of patients with chronic neck pain and cervicogenic headache (Jull et al., 2002, O'leary et al., 2003, Falla et al., 2006a). Unfortunately, because these muscles are deeply situated, traditional methods such as palpation and manual muscle testing are unreliable for assessment of their function. Secondly, it is difficult to reach the DCF with surface electromyography (EMG). Nevertheless, Falla et al. (2003) described a novel surface EMG technique for the detection of DCF muscle activity. However, this technique is not applicable for routine assessment of the DCF in clinical practice (Falla et al., 2006b, O'leary et al., 2007a).
Quantitative measurements of paraspinal muscle size can be obtained with both real-time ultrasonography (US) and magnetic resonance imaging (MRI) and there is growing support for their use in investigations of patients with spinal pain (Stokes et al., 2007, Whittaker et al., 2007, Elliott et al., 2008). MRI can be regarded as the gold standard for muscle imaging.
Real-time US, however, has the advantages of widespread accessibility and lower cost. The muscles are visualized in real-time and measurements can be obtained in a relaxed state and in different states of contraction as well as during movements (Rezasoltani et al., 2002, Kiesel et al., 2007). The disadvantages of real-time US are its relatively limited field of view and its inability to provide pilot sections for confirmation of vertebral levels when the spine is imaged. This means that strict protocols must be followed to allow accurate measurement of the soft tissues.
Today, US is frequently used as a diagnostic tool and as a biofeedback method for the muscles in the lumbo-pelvic region (Van et al., 2006). However, the use of US for the evaluation of the cervical muscles is sparse. Previous researchers have used US to evaluate the involvement of the dorsal neck muscles in chronic pain, while, to the best of our knowledge, this has not been used for the evaluation for the cervical flexor muscles (Rezasoltani et al., 1998, Rezasoltani et al., 1999, Kristjansson, 2004, Rankin et al., 2005).
The purposes of this study were 1) to set up a clear standardized protocol for the evaluation of the longus colli (LC) with US, 2) to evaluate the validity of US as compared with MRI (CSA) of the LC during rest 3) to determine the reliability of US for measuring the cross-sectional area and 4) to determine the change in CSA of the LC during contraction.
Section snippets
Subjects
US images were obtained in 27 healthy subjects (14 men and 13 women). Demographic details are shown in Table 1. Subjects were either sedentary or moderately active (0–10 h of sports a week). Exclusion criteria were pronounced neck or back trauma, neurological or inflammatory disorders, dizziness, vestibular symptoms or diabetes. The subjects should not have had neck pain, back pain or headache from cervical origin in 6 weeks before the scanning and at the moment of the scanning.
MRI images were
Validity
The within-subject differences between the MRI and US values plotted against the mean of measurements with 95% limits of agreement are seen in Fig. 4. The widely spaced limits of agreement (2SD = ±0.45) reflect the variability between the two methods. The average (±SD) CSA of the LC on MRI (1.25 cm2 ± 0.28) was larger than the CSA on US (1.22 cm2 ± 0.37), although not significant (p = 0.309).
Reliability
The ICC for the intra- and interrater reliability for the CSA of the LC was respectively 0.71 (95% CI, 0.57–0.81)
Discussion
The present study is the first, to our knowledge, to document the evaluation of CSA of the longus colli with use of US. Results from this study show that the validity and reliability of US to evaluate the CSA of the LC is doubtful, which may be due to both the anatomic structure of the muscle and some methodological limitations.
Conclusion
Results from this study show that the validity and reliability of US to evaluate the CSA of the LC is questionable, which may be due to both anatomical characteristics and methodological limitations. The small size of the muscle and difficulties in outlining the boundaries of the muscle may explain the large variability. Taking an average of different measures should be considered in further research. If further testing suggests that measurement of changes in CSA is not reliable, the use of
Acknowledgements
We would like to thank Dr. H. Vinck for his useful help during the set up of the ultrasound protocol.
References (38)
- et al.
MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD)
Man Ther
(2008) Unravelling the complexity of muscle impairment in chronic neck pain
Man Ther
(2004)- et al.
An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain
Clin Neurophysiol
(2006) - et al.
Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles
J Electromyogr Kinesiol
(2006) - et al.
Neck flexor muscle fatigue is side specific in patients with unilateral neck pain
Eur J Pain
(2004) - et al.
Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients
Man Ther
(2004) - et al.
Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging
Man Ther
(2007) Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects
Man Ther
(2004)- et al.
Measurement of segmental cervical multifidus contraction by ultrasonography in asymptomatic adults
Man Ther
(2007) - et al.
The relationship between EMG and change in thickness of transversus abdominis
Clin Biomech (Bristol, Avon)
(2004)
Muscle specificity in tests of cervical flexor muscle performance
J Electromyogr Kinesiol
Cranio-cervical flexor muscle impairment at maximal, moderate, and low loads is a feature of neck pain
Man Ther
Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages
Man Ther
Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique
Man Ther
Measuring agreement in method comparison studies
Stat Methods Res
Comparative histochemical composition of muscle fibres in a pre- and a postvertebral muscle of the cervical spine
J Anat
Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine
Spine
The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises
J Appl Physiol
Noninvasive analysis of human neck muscle function
Spine
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2017, PM and RCitation Excerpt :Reliability of this measurement method has been reported both in healthy persons and in those with neck pain [13,19]. We measured the CSA of the LCM at the C5-C6 level because it has been reported that the LCM image was clear and the overlap between the LCM and longus capitis muscle was minimum at the C5-C6 level (The path of the longus capitis muscle is separated and attached to the anterior tubercle of C6) [19]. In addition, the reliability of measurement at this level has been shown in previous studies [18,19].
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This study was supported by the Research Foundation – Flanders (FWO).