45 - Association Between Cervical Paraspinal Muscle Health and Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion

Saturday, June 3, 2023

10:38 AM – 10:40 AM

Location: Salons 10-12

Presenting Author (Person doing the Podium Present(s)

Junho Song, BS

Medical Student Research Fellow
Hospital for Special Surgery
New York, New York, United States

Co-Author(s)

TS

Tejas Subramanian, BS

Hospital for Special Surgery, United States
EZ

Eric Zhao, BS

Hospital for Special Surgery, United States
MD

Marcel Dupont, BA

Hospital for Special Surgery, United States
AP

Anthony Pajak, BS

Hospital for Special Surgery, United States
PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States
PB

Patawut Bovonratwet, MD

Orthopaedic Surgery Resident Physician
Hospital for Special Surgery
New York, New York, United States
DS

Daniel Shinn, BE

Medical Student
hospital for special surgery, United States
SD

Sidhant Dalal, BS

hospital for special surgery, United States
NS

Nishtha Singh, MBBS

hospital for special surgery, United States
TA

Tomoyuki Asada, MD

Hospital for Special Surgery, United States
OT

Olivia Tuma, BS

Hospital for Special Surgery
New York, New York, United States
KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States
SS

Sumedha Singh, MD, MBBS

Hospital for Special Surgery, United States
MK

Maximillian Korsun, BS

Hospital for Special Surgery, United States
ES

Evan Sheha, MD

Hospital for Special Surgery, United States
JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States
SQ

Sheeraz A. Qureshi, MD, MBA

Attending Surgeon
Hospital for Special Surgery
York, New York, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States

Submitter(s)

SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States

Disclosure(s):

Tejas Subramanian, BS: No financial relationships to disclose

Anthony Pajak, BS: No financial relationships to disclose

Nishtha Singh, MBBS: No financial relationships to disclose

Tomoyuki Asada, MD: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction
MRI-based measurements of lumbar paraspinal muscle health have been associated with patient-reported outcome measures (PROMs) following lumbar spine surgery. However, there is a paucity of literature evaluating the importance of cervical paraspinal muscle health on clinical outcomes following cervical spine surgery.
Aims/Objectives
To evaluate for an association between cervical paraspinal muscle health and PROMs following anterior cervical discectomy and fusion (ACDF).
Methods
Patients undergoing primary ACDF at a single institution with a minimum of 6 months follow-up were included. Axial T2-weighted MRI were assessed at C2-3 and C5-6 levels for muscle health measurements. The degree of fatty infiltration of the paraspinal muscles were assessed utilizing the Goutallier Classification. Bilateral cross-sectional areas were measured for the following muscle groups: Deep Extensors (DE), Superficial Extensors (SE), Deep Flexors (DF), Superficial Flexors (SF), Sternocleidomastoid (SCM), Trapezius. Bilateral cross-sectional areas were normalized by the square of the patient’s height to compute the cervical paraspinal muscle index (CPMI). The following PROMs were evaluated: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck pain, VAS arm pain, Short Form 12 Physical Component Score (SF-12 PCS), SF-12 Mental Component Score (MCS), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF). Mean preoperative PROMs and mean improvement in PROMs were compared based on Goutallier grade using independent t-test. Bivariate analyses were performed to assess for correlations between CPMI and PROMs. The muscle health measurements were compared between patients who achieved patient acceptable symptom state (PASS) for NDI vs. those who did not.
Results
A total of 74 patients were included (30 one-level, 26 two-level, 15 three-level, and 3 four-level ACDF). Higher Goutallier grade was significantly associated with higher preoperative NDI (37.9 vs. 30.2, p=0.029), greater change in NDI (22.8 vs. 15.5, p=0.035), greater change in VAS arm (4.0 vs. 2.6, p=0.047), and lower preoperative PROMIS-PF (39.7 vs. 44.4, p=0.036). DE CPMI significantly correlated with NDI change, preoperative VAS neck, VAS neck change, preoperative VAS arm, preoperative SF-12 PCS, and SF-12 PCS change. Lastly, patients who achieved PASS for NDI had significantly greater DE CPMI compared to those who did not meet PASS.
Conclusions
Our analysis reveals that both qualitative and quantitative measurements of cervical paraspinal muscle health are associated with patient-reported outcomes following ACDF. Greater fatty infiltration was associated with higher preoperative disability and greater postoperative improvement in pain/disability from baseline. Cross-sectional areas of the deep extensor muscles were most often found to be associated with PROMs. Greater cross-sectional areas generally correlated with lower preoperative pain/disability, greater improvement in PROMs, and higher rate of PASS achievement for NDI. Given these associations between cervical paraspinal muscle health and PROMs, assessment of baseline muscle health may serve as a valuable component of preoperative evaluation among patients undergoing ACDF.