1Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang.
2The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, P. R. China.
J Neurosurg Spine. 2024 Aug 16;41(6):726-733. doi: 10.3171/2024.5.SPINE231330. Print 2024 Dec 1.
This study investigated the correlation between Hounsfield units (HU) of the cervical vertebrae and atrophy of the cervical deep paraspinal muscles, namely the multifidus and semispinalis cervicis (SCer), in patients diagnosed with degenerative cervical myelopathy (DCM).
The authors retrospectively analyzed data from 136 patients aged 50-79 years (81 males and 55 females) who underwent surgical intervention for DCM. HU measurements of the cancellous bone in the C4 vertebra were acquired through standardized techniques. The authors evaluated fatty infiltration (FI); analyzed functional and vertebral cross-sectional area (CSA) of the multifidus and SCer at the C4-5, C5-6, and C6-7 levels; and analyzed the presence of Modic changes (MCs) and the incidence of axial neck pain.
Patients were categorized into group A (n = 56) with mean ± SD HU of 293.3 ± 15.6 and group B (n = 80) with mean ± SD HU of 389.5 ± 10.6. Both groups demonstrated significant improvements in postoperative clinical outcomes (p < 0.05); however, no statistically significant difference was observed (p > 0.05). Significant disparities in HU measurements and visual analog scale (VAS) scores for neck pain were observed between the groups (p < 0.05). The highest VAS score correlated with MCs-1 type (i.e., low signal on T1-weighted images and high signal on T2-weighted images). The functional CSA to vertebral CSA ratios of the multifidus and SCer in group A were markedly reduced compared to those of group B (p < 0.05). No significant difference was noted in functional CSA asymmetry between the groups for both muscles (p > 0.05). Lower HU measurements directly correlated with increased FI in the multifidus (p = 0.002) and SCer (p = 0.035). Furthermore, a strong positive association was found between the functional CSA to vertebral CSA ratio of the multifidus and HU values (p = 0.003), whereas HU measurements and VAS scores exhibited a negative correlation (p = 0.020).
Among those patients older than 50 years with DCM, those with decreased HU values demonstrated elevated FI levels in the multifidus and SCer muscles. Moreover, these patients presented with pronounced muscle atrophy, which correlated with axial neck pain. A significant relationship was also identified between MCs and diminished HU values.
本研究旨在探讨颈椎椎体的亨氏单位（HU）与退行性颈脊髓病（DCM）患者颈椎深部多裂肌和半棘肌（SCer）萎缩之间的相关性。
作者回顾性分析了 136 名年龄在 50-79 岁（81 名男性和 55 名女性）的患者数据，这些患者因 DCM 接受了手术治疗。通过标准化技术获取 C4 椎骨松质骨的 HU 测量值。作者评估了脂肪浸润（FI）；分析了 C4-5、C5-6 和 C6-7 水平的多裂肌和 SCer 的功能和椎体横截面积（CSA）；并分析了 Modic 改变（MCs）和轴向颈痛的发生率。
患者被分为 A 组（n=56），HU 值的平均值±标准差为 293.3±15.6，B 组（n=80），HU 值的平均值±标准差为 389.5±10.6。两组患者术后临床结局均有显著改善（p<0.05）；然而，两组之间无统计学差异（p>0.05）。两组之间的 HU 测量值和颈部疼痛视觉模拟评分（VAS）差异具有统计学意义（p<0.05）。VAS 评分最高与 MCs-1 型（即 T1 加权图像低信号和 T2 加权图像高信号）相关。与 B 组相比，A 组的多裂肌和 SCer 的功能 CSA 与椎体 CSA 的比值明显降低（p<0.05）。两组肌肉的功能 CSA 不对称均无统计学差异（p>0.05）。多裂肌（p=0.002）和 SCer（p=0.035）的 HU 值与脂肪浸润程度呈直接正相关。此外，多裂肌的功能 CSA 与 HU 值呈正相关（p=0.003），而 HU 值与 VAS 评分呈负相关（p=0.020）。
在年龄大于 50 岁的 DCM 患者中，HU 值降低的患者多裂肌和 SCer 肌肉的脂肪浸润水平升高。此外，这些患者还表现出明显的肌肉萎缩，与轴向颈痛相关。HU 值的减少与 MCs 之间也存在显著的关系。
