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Cervical Paraspinal Muscle Morphometry and Mechanical Failure: A Propensity-Matched Analysis.

Serhat Aydin1, Benjamin Carnovale1, Samuel H Wakelin1

  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

World Neurosurgery
|May 9, 2026
PubMed
Summary

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Lower preoperative paraspinal muscle volume in the neck may predict mechanical failure after posterior cervical fusion (PCDF). Preoperative MRI assessment of muscle volume could help identify patients at higher risk for hardware complications.

Area of Science:

  • Spine surgery
  • Orthopedics
  • Neurosurgery

Background:

  • Hardware complications after posterior cervical fusion (PCDF) are infrequent but significant.
  • Current risk assessment for mechanical failure primarily uses bone quality, with limited understanding of other contributing factors.
  • Paraspinal muscle morphometry is an emerging predictor of mechanical failure in lumbar spine surgery, but cervical data is scarce.

Purpose of the Study:

  • To evaluate the association between preoperative cervical paraspinal muscle morphometry and mechanical failure after PCDF.
  • To investigate if muscle volume and fatty infiltration predict complications such as proximal junctional kyphosis, distal junctional kyphosis, adjacent segment disease, or pseudoarthrosis.

Main Methods:

  • Retrospective, propensity score-matched study of 26 patients undergoing multilevel PCDF.
Keywords:
Cervical spineFatty infiltrationHardware complicationsMuscle morphometryPosterior cervical decompression and fusion

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  • Mechanical failure defined by specific radiographic or clinical outcomes.
  • Preoperative cervical MRIs (C2-T1) analyzed for paraspinal muscle volume and fatty infiltration.
  • Matched comparison between patients with and without mechanical failure.

    • Main Results:

    • Patients experiencing mechanical failure had significantly lower preoperative total paraspinal muscle volume (188 ± 38 mL vs. 224 ± 46 mL, p=0.043).
    • Total muscle volume was also significantly lower in the mechanical failure group (153 ± 33 mL vs. 184 ± 41 mL, p=0.044).
    • Individual muscle group volume reductions were observed but did not reach statistical significance.

    Conclusions:

    • Preoperative cervical paraspinal muscle volume is a significant predictor of mechanical failure risk following PCDF.
    • Routine preoperative MRI assessment of paraspinal muscle volume may aid in predicting hardware outcomes and patient risk stratification.