Paraspinal Muscle Morphology in Proximal Cervical Spondylotic Amyotrophy

This is a retrospective analysis of prospectively collected single-center observational data. The aim is to evaluate atrophy and fatty degeneration rates of cervical spinal muscles in proximal cervical spondylotic amyotrophy (PCSA).

Proximal cervical spondylotic amyotrophy affects muscles in the upper extremities. In cases that lack improvement with conservative treatment, surgery is recommended. However, preoperative factors associated with poor outcomes remain unclear. We hypothesized that assessing fatty degeneration of the cervical spinal muscles and examining its relationship with functional impairment would help predict postoperative improvement in neurological function.

This study included 18 patients who underwent PCSA surgery. We performed selective laminoplasty and foraminotomy. Preoperative paraspinal muscle cross-sectional area and fatty degeneration were quantified and correlated with neurological function.

Neurological improvement based on manual muscle testing was observed in 12/18 patients, comparing preoperative, perioperative, and over 12-month postoperative statuses. On the affected side, at the C4/5 level, fatty degeneration was more significant in the trapezius, whereas at the C5/6 level, fatty degeneration was more significant in the splenius capitis and trapezius. The fatty degeneration of the C4/5 and C5/6 trapezius was significantly correlated with preoperative muscle strength and postoperative muscle strength improvement.

The degree of fat infiltration of the muscle correlated with pre- and postoperative muscle strength at the lesion level. Thus, our results suggest a relationship between cervical muscle morphology and the clinical manifestations of PCSA. The marked increase in trapezius fatty infiltration at the C4/5 and C5/6 levels may be a valuable indicator to predict poor improvements in postoperative muscle strength.