Purpose: To assess correlation between the cross-sectional area (CSA) of posterior cervical extensor muscles (PCEMs) and the cervical sagittal alignment in Hirayama disease (HD) patients.Methods: We analyzed the MRI (Magnetic resonance imagine) T2WI and X-rays of 60 male HD patients who visited our hospital from June 2017 to February 2020. Their mean age was 18.95±1.67 years (range 16-22 years). MRI image is used to measure the CSA of cervical PCEMs. The ratio of muscle CSA to vertebral body areas (VBA) at the same level is defined as R-CSA. Cervical sagittal alignment includes C2-7 cobb angle, T1 slope, and C2-7 sagittal vertical axis (SVA). The geometric center of the C3-6 vertebral body was determined using the line connecting the C2 inferior endplate and the C7 upper endplate. When located behind the line, it is defined as a “Local kyphotic deformity” (LKD). The number of vertebral bodies involved in kyphotic deformity was determined by Local kyphosis angle (LKA) measured. Spearman correlation analysis (α=0.05) was used to determine the relationship between R-CSA and sagittal parameters. Results: Spearman correlation test revealed that R-CSA negatively correlated with T1S (S=0.34, p=0.01) and LKA (S=0.44, p=0.01) but did not correlated with C2-C7 cobb angle (S= 0.20, p=0.12) or C2-C7 SVA (S=-0.17, p=0.46). (p<0.05)Conclusions: In Hirayama disease, the CSA of PCEMs is related to T1s and LKA and exercising the PCEMs should be given enough attention.
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