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Importance of the cervical paraspinal muscles in postoperative patient-reported outcomes and maintenance of sagittal alignment after anterior cervical discectomy and fusion

医学 颈椎前路椎间盘切除融合术 矢状面 射线照相术 外科 颈椎 前凸 脊柱融合术 胸锁乳突肌 颈椎 放射科
作者
Thomas Caffard,Artine Arzani,Bruno Verna,Vidushi Tripathi,Erika Chiapparelli,Lukas Schönnagel,Jiaqi Zhu,Samuel J. Medina,Soji Tani,Gastón Camino-Willhuber,Ali E. Guven,Krizia Amoroso,Ek T. Tan,John A. Carrino,Jennifer Shue,Oliver Dobrindt,Timo Zippelius,David Dalton,Andrew A. Sama,Federico P. Girardi
出处
期刊:Journal of neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:: 1-10 被引量:1
标识
DOI:10.3171/2024.2.spine23926
摘要

OBJECTIVE The aim of this study was to investigate the influence of preoperatively assessed paraspinal muscle parameters on postoperative patient-reported outcomes and maintenance of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF). METHODS Patients with preoperative and postoperative standing cervical spine lateral radiographs and preoperative cervical MRI who underwent an ACDF between 2015 and 2018 were reviewed. Muscles from C3 to C7 were segmented into 4 functional groups: anterior, posteromedial, posterolateral, and sternocleidomastoid. The functional cross-sectional area and also the percent fat infiltration (FI) were calculated for all groups. Radiographic alignment parameters collected preoperatively and postoperatively included C2–7 lordosis and C2–7 sagittal vertical axis (SVA). Neck Disability Index (NDI) scores were recorded preoperatively and at 2 and 4–6 months postoperatively. To investigate the relationship between muscle parameters and postoperative changes in sagittal alignment, multivariable linear mixed models were used. Multivariable linear regression models were used to analyze the correlations between the changes in NDI scores and the muscles’ FI. RESULTS A total of 168 patients with NDI and 157 patients with sagittal alignment measurements with a median follow-up of 364 days were reviewed. The mixed models showed that a greater functional cross-sectional area of the posterolateral muscle group at each subaxial level and less FI at C4–6 were significantly associated with less progression of C2–7 SVA over time. Moreover, there was a significant correlation between greater FI of the posteromedial muscle group measured at the C7 level and less NDI improvement at 4–6 months after ACDF. CONCLUSIONS The findings highlight the importance of preoperative assessment of the cervical paraspinal muscle morphology as a predictor for patient-reported outcomes and maintenance of C2–7 SVA after ACDF.
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