Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes

Area of Science:

• Spinal Surgery
• Neurosurgery
• Radiology

Background:

• Degenerative cervical myelopathy (DCM) significantly impacts patient function and quality of life.
• Predicting post-operative outcomes in DCM is crucial for patient management and surgical planning.
• Cervical paraspinal muscle morphology may influence recovery after surgical decompression.

Purpose of the Study:

• To investigate if preoperative magnetic resonance imaging (MRI) metrics of cervical paraspinal muscles predict post-operative outcomes in DCM patients.
• To assess the relationship between muscle size, composition (fatty infiltration), and asymmetry with functional recovery.

Main Methods:

• 171 DCM patients underwent MRI to measure cervical muscle cross-sectional area (CSA), fat-free area (FCSA), fatty infiltration (FCSA/CSA ratio), and asymmetry.
• Measurements were taken at multiple levels, including the site of maximum cord compression.
• Linear regression analyses correlated baseline muscle metrics with modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 scores at 6 and 12 months post-surgery.

Main Results:

• Lower relative total CSA (RCSA) and greater fatty infiltration in paraspinal muscles predicted poorer mJOA and higher Nurick scores.
• Increased muscle asymmetry correlated with worse NDI and SF-36 scores post-surgery.
• Younger age was also associated with better mJOA outcomes.

Conclusions:

• Preoperative cervical paraspinal muscle morphology, particularly asymmetry and fatty infiltration, are significant predictors of functional recovery in DCM patients.
• These imaging biomarkers can aid in prognostication and guide surgical decision-making for DCM.
• Further research should explore therapeutic strategies targeting muscle health to improve surgical outcomes.