Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy

Thakar, Sumit; Mohan, Dilip; Furtado, Sunil V.; Kiran, Narayanam Anantha Sai; Dadlani, Ravi; Aryan, Saritha; Rao, Arun S; Hegde, Alangar S.

doi:10.3171/2014.4.spine13627

Cited by 36 publications

(34 citation statements)

References 32 publications

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“…Using the formula for sample size calculation for paired means and incorporating the clinically meaningful difference in CSA values from a previous study on cervical PSMs, 21 a sample size of 25 was determined to be adequate to obtain a power of 0.9 for the study. Data were entered in an Excel spreadsheet (Microsoft, Inc.) and analyzed using SPSS version 20.…”

Section: Discussionmentioning

confidence: 99%

“…The crosssectional area (CSA) measurement method was based on the technique standardized in previous studies. 1,21 Digital images of the preoperative cervical spine MRI were retrieved from the hospital radiographic system (Synapse, Fujifilm Health Systems). MR images were acquired on an HDi 1.5-T magnet (GE Signa) using a standard neurovascular coil.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

“…This was based on a previously used assumption that the muscle areas biomechanically correspond to the morphometry of the bone at any given level. 21 The occipital condyle areas (OCAs) were used for the calculation of this ratio for the RCmi area values ( Fig. 2 left), whereas the vertebral body areas (VBAs) at the cuts taken for measurement of the muscle areas were used for the RCma (Fig.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

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Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Thakar¹,

Siddappa²,

Aryan³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEThe mesodermal derangement in Chiari Type I malformation (CMI) has been postulated to encompass the cervical spine. The objectives of this study were to assess the cross-sectional areas (CSAs) of cervical paraspinal muscles (PSMs) in patients with CMI without syringomyelia, compare them with those in non-CMI subjects, and evaluate their correlations with various factors.METHODSIn this retrospective study, the CSAs of cervical PSMs in 25 patients were calculated on T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas. These values and the cervical taper ratios were then compared with those of age- and sex-matched non-CMI subjects and analyzed with respect to demographic data and clinicoradiological factors.RESULTSCompared with the non-CMI group, the mean CSA values for the rectus capitis minor and all of the subaxial PSMs were lower in the study group, and those of the deep extensors were significantly lower (p = 0.004). The cervical taper ratio was found to be significantly higher in the study cohort (p = 0.0003). A longer duration of symptoms and a steeper cervical taper ratio were independently associated with lower CSA values for the deep extensors (p = 0.04 and p = 0.03, respectively). The presence of neck pain was associated with a lower CSA value for the deep flexors (p = 0.03).CONCLUSIONSPatients with CMI demonstrate alterations in their cervical paraspinal musculature even in the absence of coexistent syringomyelia. Their deep extensor muscles undergo significant atrophic changes that worsen with the duration of their symptoms. This could be related to a significantly steeper cervical taper ratio that their cervical cords are exposed to. Neck pain in these patients is related to atrophy of their deep flexor muscles. A steeper cervical taper ratio and alterations in the PSMs could be additional indicators for surgery in patients with CMI without syringomyelia.

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Section: Discussionmentioning

confidence: 99%

Section: Radiographic Evaluationmentioning

confidence: 99%

Section: Radiographic Evaluationmentioning

confidence: 99%

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Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Thakar¹,

Siddappa²,

Aryan³

et al. 2017

Journal of Neurosurgery: Spine

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“…Given the strong correlations established between muscle mass and skeletal CSA, 32 we assumed that the muscle areas biomechanically corresponded to the morphometry of the vertebral body (VB) at any given level. 33 Thus, muscle CSA/VB CSA ratios (rather than absolute muscle CSA values) were used to eliminate biases arising from variations in patient build. The CSA of the VB was measured at the same cuts as those taken for the measurement of the muscle areas.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases

Thakar¹,

Sivaraju²,

Aryan³

et al. 2016

SPI

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OBJECTIVE The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements. METHODS The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy). RESULTS Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p < 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039). CONCLUSIONS Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar PSMs, whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of IS.

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“…Nontraumatic neck pain patients have been shown to demonstrate atrophy in most of the deep posterior compartment muscles (Elliott et al, ) whereas in chronic tension‐type headache, selective atrophy has been observed in the rectus capitis posterior major and minor muscles with relative sparing of semispinalis and splenius capitis (Fernandez‐de‐Las‐Penas et al, ). In contrast, patients with cervical spondylotic myelopathy have been shown to have atrophy in both the anterior and posterior, deep and superficial muscles (Thakar et al, ). Cervical nerve root avulsion following brachial plexus traction injuries is accurately identified by increased enhancement of multifidus in particular (Hayashi et al, ).…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging atlas of the cervical spine musculature

Perriman

Pickering

et al. 2016

Clinical Anatomy

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The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.

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Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy

Cited by 36 publications

References 32 publications

Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles

Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases

Magnetic resonance imaging atlas of the cervical spine musculature

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