Morphological Changes of Deep Extensor Neck Muscles in Relation to the Maximum Level of Cord Compression and Canal Compromise in Patients With Degenerative Cervical Myelopathy

Naghdi, Neda; Elliott, James M.; Weber, Michael H.; Fehlings, Michael G.; Fortin, Maryse

doi:10.1177/21925682221136492

Cited by 5 publications

(9 citation statements)

References 29 publications

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“…Many studies have found that muscle denervation is one of the main factors contributing to muscle atrophy and fatty infiltration of paravertebral muscles in patients with CSM. 11,12,17,18 The deep paravertebral muscles, especially the MF, are mainly composed of type I muscle fibers with a high density of spindles. Therefore, changes in the DEM morphology and composition can lead to impairments in precise motor control, proprioception, and kinesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the FCSA and FCSA/CSA of the MF and the CSA and FCSA of the SSCe declined with increasing age. Many studies have found that muscle denervation is one of the main factors contributing to muscle atrophy and fatty infiltration of paravertebral muscles in patients with CSM 11,12,17,18 . The deep paravertebral muscles, especially the MF, are mainly composed of type I muscle fibers with a high density of spindles.…”

Section: Discussionmentioning

confidence: 99%

“…did not find a significant correlation between the morphology of the extensor muscle and the mJOA. Naghdi et al 17 . proposed that the degree of the FCSA/CSA asymmetry was positively correlated with the mJOA at the level of the heaviest spinal cord compression and below.…”

Section: Discussionmentioning

confidence: 99%

“…Lin et al 29 proposed that cervical extensor asymmetry in the C6 segment was associated with sagittal imbalance in the cervical spine after modified laminoplasty. Naghdi et al 17 found that the DEM asymmetry was associated with the degree of spinal cord compression and spinal canal occupancy in patients with degenerative CSM. In our study, the MF TFCSA/TCSA asymmetry was higher in the mK-line (À) group.…”

Section: Paravertebral Extensor Muscles Asymmetrymentioning

confidence: 99%

“…11,30 However, Gu et al 18 did not find a significant correlation between the morphology of the extensor muscle and the mJOA. Naghdi et al 17 proposed that the degree of the FCSA/CSA asymmetry was positively correlated with the mJOA at the level of the heaviest spinal cord compression and below. In the present study, the postoperative mJOA and the mJOA RR were positively correlated with the INT min and the DEM CSA and negatively correlated with the degree of the MF FCSA/CSA asymmetry.…”

Section: Paravertebral Muscle Correlationmentioning

confidence: 99%

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

Wang,

Cao,

Mou

et al. 2023

Orthopaedic Surgery

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ObjectivesThe objective of this study was to quantify the morphology, composition, and asymmetry of the paravertebral extensor muscles (PSEMs) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) who had different modified K‐line (mK‐line) and the minimum interval between the mK‐line and OPLL (INTmin) values and to investigate the relationship between PSEMs and symptoms and outcomes following laminoplasty. These original findings elucidated that the atrophy of PSEMs could predict decompression outcomes and provided a theoretical basis for paraspinal muscle rehabilitation.MethodsA total of 94 consecutive patients who underwent laminoplasty for OPLL between January 2020 and January 2022 were enrolled in this retrospective study. The relative cross‐sectional areas (rCSA), functional cross‐sectional areas (rFCSA), and FCSA/CSA ratio of the multifidus (MF), semispinalis cervicalis (SSCe), semispinalis capitis (SSCa), and splenius capitis (SpCa) were measured at the C3–C7 segments on cervical magnetic resonance imaging (MRI). This study compared the differences between the mK‐line (+) group and the mK‐line (−) group, as well as between the INTmin <4 mm group and the INTmin ≥4 mm group, using the independent t‐test or Mann–Whitney test for continuous variables and the χ2‐test for categorical variables. The correlations between the PSEMs and symptoms were analyzed using either the Pearson or Spearman correlation coefficient.ResultsThe relative total CSA (rTCSA) of the PSEMs, especially the MF, was significantly smaller in the mK‐line (−) group. However, the FCSA/CSA of the right deep extensor muscle (DEM) was larger. The asymmetry of the MF TFCSA/TCSA showed a significant difference between the mK‐line groups. In the INTmin <4 mm group, the PSEMs rCSA and rFCSA were significantly smaller, while the bilateral MF TFCSA/TCSA and right SSCe TFCSA/TCSA were larger. The asymmetry of the superficial extensor muscle rCSA was significantly lower in the group with INTmin <4 mm. The postoperative modified Japanese Orthopedic Association score (mJOA) and mJOA recovery rate were positively correlated with the INTmin and DEM rCSA and negatively correlated with the asymmetry of MF FCSA/CSA.ConclusionsIn patients with mK‐line (−) or INTmin <4 mm, the PSEMs were smaller, and the DEM atrophy and composition changes were predominant. The MF asymmetry was higher in patients with mK‐lines (−), whereas the SEM atrophy and asymmetry were more prevalent in patients with INTmin <4 mm. The DEM was related to the preoperative and postoperative mJOA scores. DEM‐preserving surgery or DEM‐specific rehabilitation exercises can improve the recovery of patients with OPLL during the perioperative period. In addition, attention should be paid to the evaluation of the SEM, especially the SpCa at the C3 and C5 levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Paravertebral Extensor Muscles Asymmetrymentioning

confidence: 99%

Section: Paravertebral Muscle Correlationmentioning

confidence: 99%

See 3 more Smart Citations

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

Wang,

Cao,

Mou

et al. 2023

Orthopaedic Surgery

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Sarcopenia and the management of spinal disease in the elderly

Evans,

Smith,

Bakhsheshian

et al. 2024

GeroScience

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The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2–T2 Posterior Cervical Fusion

Levy,

Pinter,

Pumford

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective cohort analysis. Objective: To determine whether the C2 exposure technique was a predictor of change in cervical alignment and patient-reported outcomes measures (PROMs) after posterior cervical decompression and fusion (PCDF) for degenerative indications. Background: In PCDF handling of the C2 posterior paraspinal musculature during the operative approach varies by surgeon technique. To date, no studies have investigated whether maintenance of the upper cervical semispinalis cervicis attachments as compared with complete reflection of upper cervical paraspinal musculature from the posterior bony elements is associated with superior radiographic and clinical outcomes after PCDF. Patients and Methods: All adult patients who underwent C2–T2 PCDF for myelopathy or myeloradiculopathy at multi-institutional academic centers between 2013 and 2020 were retrospectively identified. Patients were dichotomized by the C2 exposure technique into semispinalis preservation or midline muscular reflection groups. Preoperative and short and long-term postoperative radiographic outcomes (upper cervical alignment, global alignment, and fusion status) and PROMs (Visual Analog Scale–Neck, Neck Disability Index, and Short Form-12) were collected. Univariate analysis compared patient factors, radiographic measures, and PROMs across C2 exposure groups. Results: A total of 129 patients met the inclusion/exclusion criteria (73 muscle preservation and 56 muscle reflection). Patients in the muscular preservation group were on average younger (P= 0.005) and more likely to have bone morphogenic protein (P< 0.001) and C2 pars screws (P= 0.006) used during surgery. Preoperative to postoperative changes in C2 slope, C2 tilt, C2–C3 segmental lordosis, C2–C3 listhesis, C0–C2 Cobb angle, proximal junctional kyphosis, ADI, C1 lamina-occiput distance, C2 sagittal vertical axis, C2–C7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 exposure technique. Likewise, there were no significant differences in fusion status, C2–C3 pseudoarthrosis, C2 screw loosening, and complication and revision rates between C2 exposure groups. Conclusions: Preservation of C2 semispinalis attachments versus muscular reflection did not significantly impact cervical alignment, clinical outcomes, or proximal junction complications in long-segment PCDF. Level of Evidence: Level III.

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Morphological Changes of Deep Extensor Neck Muscles in Relation to the Maximum Level of Cord Compression and Canal Compromise in Patients With Degenerative Cervical Myelopathy

Cited by 5 publications

References 29 publications

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

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

Sarcopenia and the management of spinal disease in the elderly

The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2–T2 Posterior Cervical Fusion

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