Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Abstract

Study Design: A retrospective observational study. Objective: To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods: Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. Results: 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae ( ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL ( ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. Conclusions: Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.

Effects of Cervical Paravertebral Extensors in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Grouped According to mK‐Line

“…In previous studies, it was found that extensive OPLL in the C4/5 segments reduced mobility in the cervical spine and resulted in increased fatty infiltration of the MF and SSCe. 13 Increased C2-C7 SVA increased the area of the intervertebral foramen and reduced neural compression. 27 Therefore, the increased C2-C7 SVA in OPLL patients might be a compensatory postural mechanism.…”

“…8,9 Several studies have found that the paravertebral muscles in cervical spondylotic myelopathy (CSM) and OPLL have a reduced volume and altered composition compared to normal asymptomatic populations. [10][11][12][13] Cervical paravertebral muscles can affect postural control, stability, feedback neuromodulation, and sagittal alignment. 14 However, the relationship between paravertebral muscles and the prognosis of OPLL remains unclear, and there is still a lack of studies quantifying the role of extensor muscles.…”

“…Sarcopenia leads to generalized muscle atrophy and decreased muscle mass and function, and it is a significant predictor of poor treatment outcomes 8,9 . Several studies have found that the paravertebral muscles in cervical spondylotic myelopathy (CSM) and OPLL have a reduced volume and altered composition compared to normal asymptomatic populations 10–13 . Cervical paravertebral muscles can affect postural control, stability, feedback neuromodulation, and sagittal alignment 14 .…”

Reduced volume and altered composition of paraspinal muscles in Marfan syndrome: A retrospective cohort study

“…[18][19][20][21][22][23][24] Muscle CSA and FI% were measured using a radiological workstation as previously described. [2,[25][26][27] Following previous reports, the CSA of the bilateral PM and PVM, which included multifidus and erector spinae, as well as the vertebral body, were measured by constructing polygon point outlines of the individual muscles and calculated in square millimeters (Fig. 1).…”

Imaging of muscle and adipose tissue in the spine: A narrative review

“…Furthermore, the neck disability index score and fat infiltration rate were significantly higher in patients with continuous or mixed OPLL than in those with focal OPLL. [ 28 ] Function of the paraspinal muscle group is also associated with postoperative complications. Usami et al [ 29 ] evaluated the swelling of the multifidus muscle in the early postoperative period using magnetic resonance imaging and found that the gradual swelling of the multifidus muscle was accompanied by a gradual increase in nerve traction, which resulted in the development of C5 nerve root palsy.…”