The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

Abstract

Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient's functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient's postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expres-sion. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.

The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery

“…Additionally, in agreement with studies examining paraspinal muscle ( 4 , 11 , 25 ), our findings reveal that FI is more prevalent in elderly patients. In contrast to earlier findings ( 26 ), however, no evidence of association between FI and gender or BMI was detected in our research.…”

“…In the current study, improved clinical outcomes reflected by VAS, JOA score, and NDI demonstrated that HS effectively ameliorated neurological symptoms, consistent with previous findings reported by Scott-Young et al (27). More importantly, numerous studies in the past linked muscle FI to postoperative pain or neurological deficits, particularly following lumbar spine and posterior cervical surgery (4,13,26). In a recent systematic review of 873 patients, Jermy et al recently identified a link between a low FI and greater improvement in low back pain and disability following lumbar spine surgery (12).…”

“…However, these results are contradicted by the present study, which found that FI of CPM had no impact on patient-reported outcomes after HS. One possible explanation for our findings is that anterior surgery results in less obstruction to the paraspinal muscle ( 26 ). Additionally, compared with single-level CDDD, the clinical recovery of HS patients in the present study following multi-level decompression would theoretically be more significant.…”

“…( 27 ). More importantly, numerous studies in the past linked muscle FI to postoperative pain or neurological deficits, particularly following lumbar spine and posterior cervical surgery ( 4 , 13 , 26 ). In a recent systematic review of 873 patients, Jermy et al.…”

“…Therefore, muscle strength measurements are required in the future for studying neck muscles. Moreover, both the anterior and posterior paravertebral muscles are reported to contribute to the maintenance of cervical posture and control intervertebral motion ( 26 ). In addition to assessing ratio of CSA, more quantitative and qualitative indicators are warranted.…”