Association between severity of the cervical foraminal stenosis and paraspinal muscle parameters in patients undergoing anterior cervical discectomy and fusion

Thomas Caffard Spine Care Institute, Hospital for Special Surgery, New York, New York;
Department of Orthopedic Surgery, University of Ulm, Germany;

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Artine Arzani Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Bruno Verna Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Vidushi Tripathi Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Samuel J. Medina Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Lukas Schönnagel Spine Care Institute, Hospital for Special Surgery, New York, New York;
Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany;

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Erika Chiapparelli Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Soji Tani Spine Care Institute, Hospital for Special Surgery, New York, New York;
Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan;

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Gaston Camino-Willhuber Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Ali E. Guven Spine Care Institute, Hospital for Special Surgery, New York, New York;
Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany;

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Krizia Amoroso Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Jiaqi Zhu Biostatistics Core, Hospital for Special Surgery, New York, New York; and

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Ek Tsoon Tan Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York

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John A. Carrino Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York

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Hassan Awan Malik Department of Orthopedic Surgery, University of Ulm, Germany;

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Timo Zippelius Department of Orthopedic Surgery, University of Ulm, Germany;

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Jennifer Shue Spine Care Institute, Hospital for Special Surgery, New York, New York;

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David M. Dalton Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Andrew A. Sama Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Federico P. Girardi Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Frank P. Cammisa Spine Care Institute, Hospital for Special Surgery, New York, New York;

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Alexander P. Hughes Spine Care Institute, Hospital for Special Surgery, New York, New York;

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OBJECTIVE

The cervical multifidus and rotatores muscles are innervated by the posterior rami of the spinal nerves of the corresponding level, and it has been hypothesized that cervical foraminal stenosis (CFS) affecting the spinal nerves results in changes in these muscles. The purpose of this study was to evaluate the relationship between the severity of CFS and fat infiltration (FI) of the multifidus and rotatores muscles.

METHODS

Patients who received preoperative cervical MRI, underwent anterior cervical decompression and fusion between 2015 and 2018, and met inclusion and exclusion criteria were included. Multifidus and rotatores muscles were segmented bilaterally from C3 to C7, and the percent FI was measured using custom-written MATLAB software. The severity of the CFS was assessed by the Kim classification. Multivariable linear mixed models were conducted and adjusted for age, sex, BMI, and repeated measures.

RESULTS

In total, 149 patients were included. Linear mixed modeling results showed that a more severe CFS at C3–4 was correlated with a greater FI of the multifidus and rotatores muscles at C4 (estimate 0.034, 95% CI 0.003–0.064; p = 0.031), a more severe CFS at C4–5 was correlated with a greater FI of the multifidus and rotatores muscles at C5 (estimate 0.037, 95% CI 0.015–0.057; p < 0.001), a more severe CFS at C5–6 was correlated with a greater FI of the multifidus and rotatores muscles at C6 (estimate 0.041, 95% CI 0.019–0.062; p < 0.001) and C7 (estimate 0.035, 95% CI 0.012–0.058; p = 0.003), and a more severe CFS at C6–7 was correlated with a greater FI of the multifidus and rotatores muscles at C7 (estimate 0.049, 95% CI 0.027–0.071; p < 0.001).

CONCLUSIONS

These results demonstrated level- and side-specific correlations between the FI of the multifidus and rotatores muscles and severity of CFS. Given the segmental innervation of the multifidus and rotatores muscles, the authors hypothesize that the observed increased FI could be reflective of changes due to muscle denervation from CFS.

ABBREVIATIONS

ACDF = anterior cervical decompression and fusion; CFS = cervical FS; FI = fat infiltration; FS = foraminal stenosis; ICC = intraclass correlation coefficient; mFI-5 = 5-factor modified frailty index; ROI = region of interest.
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