Quantifying Dysfunction of the Lumbar Multifidus Muscle After Radiofrequency Neurotomy and Fusion Surgery: A Preliminary Study.

The multifidus is an important muscle for the active stabilization of the spine. Unfortunately, clinical procedures such as posterior lumbar fusion (PLF) and radio frequency neurotomy (RFN) cause injury to these muscles affecting their function. However, evaluating multifidus function using traditional biomechanical methods is challenging due to its unique anatomical features. The change in muscle shear modulus during contraction has been corrected to force generation for several skeletal muscles. Therefore, the change in shear modulus can be used to quantify muscle contraction. The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. We used our recently developed protocol which consists of measuring changes of multifidus shear modulus at lying prone, sitting up, and sitting up with the arms lifted. In healthy individuals, the median multifidus shear modulus increased progressively from prone, sitting, and sitting with arms raised: 18.55 kPa, 27.14 kPa, and 38.45 kPa, respectively. A moderate increase in shear modulus for these body positions was observed in PLF patients: 9.81 kPa, 17.26 kPa, and 21.85 kPa. In RFN patients, the shear modulus remained relatively constant: 14.44 kPa, 16.57 kPa, and 17.26 kPa. Overall, RFN and PLF caused a reduction in the contraction of multifidus muscles. However, the contraction of multifidus muscle slightly increased during multifidus activation in PLF patients, while it did not change in RFN patients. These preliminary measurements suggest that the proposed protocol using SWE can provide important information about the function of individual spine muscles to guide the design and evaluation of postsurgical rehabilitation protocols.

Measurement of the shear modulus in thin-layered tissues using numerical simulations and shear wave elastography.

Measurement of mechanical properties of thin-layered tissues has broad applications in the diagnosis of several pathologies. Ultrasound shear wave elastography (SWE) measures the shear wave speed as a means of estimating the mechanical properties of tissues. However, the wave speed in thin-layered tissues is affected by their thickness and the properties of surrounding tissues. The objective of this study is to introduce a method that combines numerical simulations and SWE measurements to provide a more accurate calculation of shear modulus in layered tissues. In the proposed method, the spatial distribution of the acoustic radiation force (ARF) emitted by the transducer was first computed. The ARF was then used as input for simulating the guided wave propagation in the thin layer with its surroundings. The simulations were repeated for several values of the shear modulus of the layer to obtain the corresponding simulated wave speed. By comparing the measured and simulated wave speeds, a more accurate (corrected) shear modulus can be obtained. The proposed method was validated using experiments in agarose gels. In-vivo SWE measurements were also performed for the fascia of the tibialis anterior (TA) muscle and the aponeurosis of musculotendinous junction (MTJ) in medial gastrocnemius (MG) head in a group of healthy individuals. The simulated and measured wave speed in gel constructs were in good agreement with a maximum error of 7.22%. The average of measured wave speed of fascia and aponeurosis was 3.90 ±â€¯0.16 m/s and 2.33 ±â€¯0.60 m/s, while the corresponding corrected shear modulus was 95.63 ±â€¯17.89 kPa and 6.36 ±â€¯8.98 kPa, respectively. Thickness had a substantial effect on the wave speed in thin-layered tissues with decreasing speed for thinner tissues. The SWE-based simulation method presented in this study has the potential of enhancing clinical assessment for several musculoskeletal conditions involving thin-layered tissues.

Changes in Shear Modulus of the Lumbar Multifidus Muscle During Different Body Positions.

Multifidus function is important for active stabilization of the spine, but it can be compromised in patients with chronic low back pain and other spine pathologies. Force production and strength of back muscles are often evaluated using isometric or isokinetic tests, which lack the ability to quantify multifidi contribution independent of the erector spinae and adjacent hip musculature. The objective of this study is to evaluate localized force production capability in multifidus muscle using ultrasound shear wave elastography (SWE) in healthy individuals. Three different body positions were considered: lying prone, sitting up, and sitting up with the right arm lifted. These positions were chosen to progressively increase multifidus contraction and to minimize body motion during measurements. Shear modulus was measured at the superficial and deeper layers of the multifidus. Repeatability and possible sources of error of the shear modulus measurements were analyzed. Multifidus shear modulus (median (interquartile range)) increased from prone, i.e., 16.15 (6.69) kPa, to sitting up, i.e., 27.28 (15.72) kPa, to sitting up with the right arm lifted position, i.e., 45.02 (25.27) kPa. Multifidi shear modulus in the deeper layer of the multifidi was lower than the superficial layer, suggesting lower muscle contraction. Intraclass correlation coefficients (ICCs) for evaluation of shear modulus by muscle layer were found to be excellent (ICC = 0.76-0.80). Results suggest that the proposed protocol could quantify local changes in spinal muscle function in healthy adults; further research in patients with spine pathology is warranted.

Narrowband Shear Wave Generation Using Sinusoidally Modulated Acoustic Radiation Force.

Most transient ultrasound elastography methods use high-intensity ultrasound "push" pulses that generate a shear wave with a wide frequency spectrum. However, it is difficult to control how the energy of the wave is distributed within that spectrum. For this reason, the shear-wave group velocity may not match that of harmonic methods like magnetic resonance elastography (MRE). The objective of this study was to introduce a narrowband shear wave generation method produced by "push" pulses with sinusoidally modulated intensity. The method, named harmonic shear wave imaging (HSWI), successively transmits a series of push pulses with a periodic change in duration. The excited shear waves form a continuous shear wave with a known main frequency that can be controlled by the user. Push pulses are interleaved with imaging pulses so only one clinical transducer is used to generate and record the shear waves. The proposed method was compared to MRE and a transient shear wave elastography method using phantoms and in vivo measurements. It was found that HSWI produces narrowband waves with a speed that closely matches that measured by MRE. Measurement of the acoustic output parameters indicated that the acoustic intensities in HSWI are suitable for clinical applications. The ability of HSWI to generate narrowband shear waves using a single linear array transducer makes it amenable for clinical translation. HSWI can potentially use the same thresholds as MRE for diagnosis of diseases affecting the stiffness of soft tissues.

The shear modulus of lower-leg muscles correlates to intramuscular pressure.

Shear wave elastography (SWE) is emerging as an innovative tool to evaluate muscle properties and function. It has been shown to correlate with both passive and active muscle forces, and is sensitive to physiological processes and pathological conditions. Similarly, intramuscular pressure (IMP) is an important parameter that changes with passive and active muscle contraction, body position, exercise, blood pressure, and several pathologies. Therefore, the objective of this study was to quantify the dependency of shear modulus within the lower-leg muscles on IMP in healthy individuals. Nineteen healthy individuals (age: Mean age ±â€¯SD, 23.84 ±â€¯6.64 years) were recruited. Shear modulus was measured using ultrasound SWE on the tibialis anterior (TA) and peroneus longus (PL) muscles using pressure cuff inflation around the thigh at 40 mmHg, 80 mmHg, and 120 mmHg. Changes in IMP were verified using a catheter connected to a blood pressure monitor. It was found that IMP was correlated to TA and PL shear modulus (spearman's rank correlation = 0.99 and 0.99, respectively). Applying a gradual increase of cuff pressure from 0 to 120 mmHg increased the shear modulus of the TA and PL muscles from 15.83 (2.46) kPa to 21.88 (4.33) kPa and from 9.64 (1.97) kPa to 12.88 (5.99) kPa, respectively. These results demonstrate that changes of muscle mechanical properties are dependent on IMP. This observation is important to improve interpretation of ultrasound elastograms and to potentially use it as a biomarker for more accurate diagnosis of pathologies related to increased IMP.

Change in skeletal muscle stiffness after running competition is dependent on both running distance and recovery time: a pilot study.

Long-distance running competitions impose a large amount of mechanical loading and strain leading to muscle edema and delayed onset muscle soreness (DOMS). Damage to various muscle fibers, metabolic impairments and fatigue have been linked to explain how DOMS impairs muscle function. Disruptions of muscle fiber during DOMS exacerbated by exercise have been shown to change muscle mechanical properties. The objective of this study is to quantify changes in mechanical properties of different muscles in the thigh and lower leg as function of running distance and time after competition. A custom implementation of Focused Comb-Push Ultrasound Shear Elastography (F-CUSE) method was used to evaluate shear modulus in runners before and after a race. Twenty-two healthy individuals (age: 23 ± 5 years) were recruited using convenience sampling and split into three race categories: short distance (nine subjects, 3-5 miles), middle distance (10 subjects, 10-13 miles), and long distance (three subjects, 26+ miles). Shear Wave Elastography (SWE) measurements were taken on both legs of each subject on the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), soleus, lateral gastrocnemius (LG), medial gastrocnemius (MG), biceps femoris (BF) and semitendinosus (ST) muscles. For statistical analyses, a linear mixed model was used, with recovery time and running distance as fixed variables, while shear modulus was used as the dependent variable. Recovery time had a significant effect on the soleus (p = 0.05), while running distance had considerable effect on the biceps femoris (p = 0.02), vastus lateralis (p < 0.01) and semitendinosus muscles (p = 0.02). Sixty-seven percent of muscles exhibited a decreasing stiffness trend from before competition to immediately after competition. The preliminary results suggest that SWE could potentially be used to quantify changes of muscle mechanical properties as a way for measuring recovery procedures for runners.