Evaluation Of Cervical Para-cervical Muscle Degeneration In Patients With Cervical Spondylotic Myelopathy And Correlation Analysis With Sagittal Parameters

Object: The purpose of this study was to investigate the functional status of cervical paraspinal muscle MRI in patients with cervical spondylotic myelopathy(CSM),and to explore its influence on cervical sagittal balance and cervical range of motion.Method: Thirty patients with cervical spondylotic myelopathy(CSM)admitted to the Department of Orthopedics of the 83 rd Group Military Hospital of the PLA from January2019 to January 2022 and 42 healthy people who underwent physical examination at the same time were selected as the study subjects,respectively as the observation group and the control group.Based on cervical MRI in both groups,The muscle cross-sectional area(CSA),effective cross-sectional area(ECSA),relative cross-sectional area(RCSA)and fat infiltration degree(FI)of cervical multifidus(MF),semispinalis cervicis(SCer),semispinalis capitis(SCap),splenius capitis(SPL)and longus colli(LC)were measured by Image J software.All measurements were completed by two physicians skilled in the imaging measurement of cervical muscle.The mean value of the results was taken,and 15 cases of repeated measurements were selected from the two groups for methodological research.Based on the preoperative standard cervical spine anteroposterior and lateral and over-extension and over-flexion X-ray films of patients in the observation group,cervical sagittal position balance parameters and cervical range of motion indexes were measured.A bilateral random model of Intraclass correlation coefficient(ICC)was used to evaluate the consistency of the measurement of the level of para-cervical muscle degeneration by Image J software.The level of para-cervical muscle degeneration was compared between the two groups by the two-sample t test.Pearson correlation coefficient was used to evaluate the influence of cervical paraspinal muscle degeneration on imaging indicators related to cervical sagittal position in the observation group.Result: The intergroup ICC measured by cervical paraspinal muscle CSA were 0.846 ~0.936 and 0.796 ~ 0.949 in the observation group and the control group,respectively,and the intragroup ICC were 0.825 ~ 0.953 and 0.771 ~ 0.936,respectively.The intergroup ICC measured by parascervical muscle FI were 0.811 ~ 0.941 and 0.772 ~ 0.892 in the observation group and the control group,respectively,and the intragroup ICC were 0.771 ~0.956 and 0.768 ~ 0.886,respectively.The mean values of CSA and RCSA in the multifidus,semispinalis capitis and splenius capitis of the observation group were significantly higher than those of the control group(P< 0.05),and the mean value of ECSA was not significantly different from that of control group(P>0.05);The mean values of CSA,RCSA and ECSA of longus colli and semispinalis cervicis in the observation group were not significantly different from those in the control group(P>0.05);Compared with the control group,the average FI values of the multifidus,semispinalis cervicis,semispinalis capitis,splenius capitis and longus colli in the observation group were significantly increased(P<0.05).ECSA of splenius capitis was negatively correlated with cervical flexion Angle(P<0.05),the rest of the paracervical muscle groups had no significant correlation with cervical sagittal position parameters.CSA,RCSA,ECSA of longus colli were negatively correlated with the cervical lordosis Angle(P<0.05),CSA and ECSA of longus colli were negatively correlated with cervical hyperextension Angle and flexion extension Angle(P< 0.01),cervical longus FI was positively correlated with C2-7SVA(P< 0.05).Con LCusion: The Image J software based on cervical MRI can effectively reflect the imaging function of the paraspinal muscles of the cervical spine.The degeneration of the cervical paraspinal muscles in patients with CSM was mainly manifested as the increase of the cross-sectional area and the change of adipose,among which the hypertrophy and hypertrophy of the hemipinous and pinus cephali muscles were the most significant.The degeneration of the longus cervical muscle is closely related to sagittal disequilibrium and limited hyperextension of motion of the cervical spine.