Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Endocrinol (Lausanne). 2023 Feb 9;14:1128810. doi: 10.3389/fendo.2023.1128810. eCollection 2023.
The cervical paraspinal muscle (CPM) has an essential role in positioning, stabilizing and directing the cervical spine. However, information is lacking regarding the influence of CPM on outcomes following anterior cervical surgery. This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes in patients undergoing hybrid surgery (HS) and analyze the relationship between FI and cross-sectional area (CSA) of CPM.
A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level HS. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons.
Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p = 0.053). No statistically significant differences were presented among the three groups regarding pre- and postoperative clinical evaluation scores. The cervical lordosis was significantly higher in the normal group before surgery (p = 0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p = 0.046). The function spine unit angle and disc angle of arthroplasty levels were significantly lower in the severe group than the normal group at follow-ups. Moreover, after correction according to vertebral body area, no statistically significant relationship existed between CSA ratio and FI grade.
CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and postoperative sagittal balance disorder, particularly in C2-7 SVA and segmental alignment of arthroplasty level. Meanwhile, FI of CPM appears to have no impact on clinical outcomes and reveals small correlations to CSA.
颈旁肌（CPM）在颈椎定位、稳定和引导方面起着重要作用。然而，关于 CPM 对颈椎前路手术后结果的影响的信息还很缺乏。本研究旨在评估 CPM 脂肪浸润（FI）与行杂交手术（HS）患者术后结果的相关性，并分析 FI 与 CPM 横截面积（CSA）之间的关系。
对 110 例连续行 2 节段 HS 的患者进行回顾性分析。根据多裂肌 FI 的 Goutallier 分级，将患者分为正常、中度和重度组。使用 Image J 软件对 CPM 进行描边和分析。收集和评估临床结果和影像学参数以进行相关比较。
69.1%（76/110）的患者存在明显的 FI，老年患者中更为明显（p = 0.053）。三组患者的术前和术后临床评估评分无统计学差异。正常组患者术前颈椎前凸明显更高（p = 0.029）。同样，终末随访时重度组 SVA 明显高于正常组（p = 0.046）。重度组患者的功能脊柱单位角和置换节段椎间盘角在随访时明显低于正常组。此外，根据椎体面积校正后，CSA 比值与 FI 分级之间无统计学意义的相关性。
颈椎间盘退行性疾病患者的 CPM 退变是常见的，且与年龄相关。更重要的是，CPM 严重 FI 与术后矢状位平衡紊乱显著相关，尤其是 C2-7 SVA 和置换节段的节段性排列。同时，CPM 的 FI 似乎对临床结果没有影响，与 CSA 显示出较小的相关性。
