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Based on preoperative MRI assessment using the Goutallier classification system, patients were stratified into three groups according to the degree of paraspinal muscle fat infiltration: mild (Grade 0\u20131,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936), moderate (Grade 1.5\u20132,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931), and severe (Grade 2.5\u20134,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924). Baseline data, key sagittal radiographic parameters, and clinical outcome scores (JOA, NDI, VAS) were compared among groups. Multiple linear regression analysis was performed to identify independent factors associated with the VAS score at 2-year follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Postoperative radiographic parameters, including the T1 slope, C2 slope, C2\u2013C7 Cobb angle, C0\u2013C2 Cobb angle, sagittal segmental angle (SSA), and average segmental disc height (ASDH), significantly improved in all patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Clinical scores (JOA, NDI, VAS) also showed significant improvement at the 2-year follow-up (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). However, the severe fat infiltration group demonstrated significantly worse immediate postoperative VAS scores, as well as worse NDI and VAS scores at the 2-year follow-up compared to the mild and moderate groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Multiple linear regression analysis confirmed that the preoperative Goutallier grade was a significant independent factor associated with a higher VAS score at 2 years (B\u2009=\u20090.962,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), after adjusting for relevant covariates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACDF effectively improves clinical symptoms and cervical alignment in older CSM patients. However, severe preoperative paraspinal muscle fat infiltration is independently associated with inferior postoperative pain relief and functional recovery. Assessment of paraspinal muscle status may be useful for risk stratification in older patients undergoing ACDF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-08026-0","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:49:27Z","timestamp":1784897367000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of paraspinal fat infiltration with postoperative clinical outcomes in older cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion"],"prefix":"10.1186","volume":"26","author":[{"given":"Yan","family":"Gong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suliang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyang","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Zhuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhensong","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jintao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"issue":"2","key":"8026_CR1","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1007\/s10143-021-01698-9","volume":"45","author":"G Baucher","year":"2022","unstructured":"Baucher G, Taskovic J, Troude L, et al. 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