{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:12:33Z","timestamp":1787955153799,"version":"build-2784847793"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The objective of this study was to assess the cross-sectional areas (CSAs) of the superficial, deep flexor (DF), and deep extensor (DE) paraspinal muscles in patients with cervical spondylotic myelopathy (CSM), and to evaluate their correlations with functional status and sagittal spinal alignment changes following central corpectomy with fusion and plating.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective study of 67 patients who underwent central corpectomy with fusion and plating for CSM, the CSAs of the paraspinal muscles were calculated on the preoperative T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas (VBAs) and as flexor\/extensor CSA ratios. These ratios were then compared with those in the normative population and analyzed with respect to various clinicoradiological factors, including pain status, Nurick grade, and segmental angle change at follow-up (SACF).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The mean CSA values for all muscle groups and the DF\/DE ratio were significantly lower in the study cohort compared with an age- and sex-matched normative study group (p &lt; 0.001). Among various independent variables tested in a multivariate regression analysis, increasing age and female sex significantly predicted a lower total extensor CSA\/VBA ratio (p &lt; 0.001), while a longer duration of symptoms significantly predicted a greater total flexor\/total extensor CSA ratio (p = 0.02). In patients undergoing single-level corpectomy, graft subsidence had a positive correlation with SACF in all patients (p &lt; 0.05), irrespective of the preoperative segmental angle and curvature, while in patients undergoing 2-level corpectomy, graft subsidence demonstrated such a correlation only in the subgroup with lordotic curvatures (p = 0.02). Among the muscle area ratios, the DF\/DE ratio demonstrated a negative correlation with SACF in the subgroup with preoperative straight or kyphotic segmental angles (p = 0.04 in the single corpectomy group, p = 0.01 in the 2-level corpectomy group). There was no correlation of any of the muscle ratios with change in Nurick grade.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Patients with CSM demonstrate significant atrophy in all the flexor and extensor paraspinal muscles, and also suffer a reduction in the protective effect of a strong DF\/DE CSA ratio. Worsening of this ratio significantly correlates with greater segmental kyphotic change in some patients. A physiological mechanism based on DF dysfunction is discussed to elucidate these findings that have implications in preventive physiotherapy and rehabilitation of patients with CSM. Considering that the influence of a muscle ratio was significant only in patients with hypolordosis, a subgroup that is known to have facetal ligament laxity, it may also be postulated that ligamentous support supersedes the influence of paraspinal muscles on postoperative sagittal alignment in CSM.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.4.spine13627","type":"journal-article","created":{"date-parts":[[2014,5,30]],"date-time":"2014-05-30T14:00:58Z","timestamp":1401458458000},"page":"223-230","source":"Crossref","is-referenced-by-count":43,"title":["Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy"],"prefix":"10.3171","volume":"21","author":[{"given":"Sumit","family":"Thakar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip","family":"Mohan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil V.","family":"Furtado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayanam Anantha","family":"Sai Kiran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Dadlani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saritha","family":"Aryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun S.","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alangar S.","family":"Hegde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine13627","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1097\/00007632-200204010-00005","article-title":"Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine","volume":"27","author":"Boyd-Clark","year":"2002"},{"key":"b2-spine13627","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1007\/s00586-009-0898-8","article-title":"MRI analysis of muscle\/fat index of the superficial and deep neck muscles in an asymptomatic cohort","volume":"18","author":"Cagnie","year":"2009"},{"key":"b3-spine13627","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"328","DOI":"10.2106\/00004623-199072030-00003","article-title":"Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation","volume":"72","author":"Carman","year":"1990"},{"key":"b4-spine13627","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1097\/00007632-199710010-00003","article-title":"Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture","volume":"22","author":"Cholewicki","year":"1997"},{"key":"b5-spine13627","series-title":"J Oral Rehabil","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/j.1365-2842.2009.01943.x","article-title":"Comparison of pain thresholds and pain tolerance levels between Middle Easterners and Swedes and between genders","volume":"36","author":"Dawson","year":"2009"},{"key":"b6-spine13627","series-title":"Man Ther","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.math.2007.01.012","article-title":"MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD)","volume":"13","author":"Elliott","year":"2008"},{"key":"b7-spine13627","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1002\/ca.20252","article-title":"Magnetic resonance imaging study of cross-sectional area of the cervical extensor musculature in an asymptomatic cohort","volume":"20","author":"Elliott","year":"2007"},{"key":"b8-spine13627","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"348","DOI":"10.3171\/2010.10.SPINE091029","article-title":"Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. Clinical article","volume":"14","author":"Furlan","year":"2011"},{"issue":"6 Suppl","key":"b9-spine13627","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S77","DOI":"10.1097\/00007632-199206001-00003","article-title":"Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation","volume":"17","author":"Highland","year":"1992"},{"key":"b10-spine13627","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1097\/01.brs.0000221985.37468.0f","article-title":"Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy","volume":"31","author":"Ikenaga","year":"2006"},{"key":"b11-spine13627","series-title":"Man Ther","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/S1356-689X(03)00086-9","article-title":"Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients","volume":"9","author":"Jull","year":"2004"},{"key":"b12-spine13627","series-title":"J Manipulative Physiol Ther","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.jmpt.2008.08.003","article-title":"Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test","volume":"31","author":"Jull","year":"2008"},{"key":"b13-spine13627","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"208","DOI":"10.2176\/nmc.51.208","article-title":"Detailed study of graft sinking and worsening of the fused segment angle in patients with cervical disease treated with the Williams-Isu method","volume":"51","author":"Kim","year":"2011"},{"issue":"1 Suppl Spine","key":"b14-spine13627","series-title":"J Neurosurg","first-page":"2","article-title":"Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence","volume":"100","author":"Kulkarni","year":"2004"},{"key":"b15-spine13627","series-title":"Biometrics","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977"},{"key":"b16-spine13627","series-title":"Eur J Endocrinol","first-page":"51","article-title":"Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area and paraspinal muscle area in hypogonadal men","volume":"138","author":"Leifke","year":"1998"},{"key":"b17-spine13627","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s00586-011-1978-0","article-title":"Changes in the cross-sectional area of deep posterior extensor muscles of the cervical spine after anterior decompression and fusion: 10-year follow-up study using MRI","volume":"21","author":"Matsumoto","year":"2012"},{"key":"b18-spine13627","series-title":"Ergonomics","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1080\/00140138908966121","article-title":"Strength and cross-sectional area of the dorsal neck muscles","volume":"32","author":"Mayoux-Benhamou","year":"1989"},{"key":"b19-spine13627","series-title":"J Orthop Res","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1002\/jor.1100060514","article-title":"Analysis and measurement of neck loads","volume":"6","author":"Moroney","year":"1988"},{"issue":"1","key":"b20-spine13627","series-title":"Cochrane Database Syst Rev","first-page":"CD001466","article-title":"Surgery for cervical radiculopathy or myelopathy","author":"Nikolaidis","year":"2010"},{"key":"b21-spine13627","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1007\/s00586-011-1774-x","article-title":"Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study","volume":"20","author":"Okada","year":"2011"},{"key":"b22-spine13627","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.spinee.2009.09.006","article-title":"Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification","volume":"10","author":"Park","year":"2010"},{"key":"b23-spine13627","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1227\/01.NEU.0000054218.50113.40","article-title":"Changes in cervical spine curvature after uninstrumented one- and two-level corpectomy in patients with spondylotic myelopathy","volume":"52","author":"Rajshekhar","year":"2003"},{"key":"b24-spine13627","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1227\/01.NEU.0000159713.20597.0F","article-title":"Functional outcome after central corpectomy in poor-grade patients with cervical spondylotic myelopathy or ossified posterior longitudinal ligament","volume":"56","author":"Rajshekhar","year":"2005"},{"key":"b25-spine13627","series-title":"Br J Sports Med","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1136\/bjsm.2004.013961","article-title":"Cervical muscle strength measurement in two groups of elite Greco-Roman and free style wrestlers and a group of non-athletic subjects","volume":"39","author":"Rezasoltani","year":"2005"},{"key":"b26-spine13627","series-title":"J Musculoskelet Neuronal Interact","first-page":"232","article-title":"From mechanostat theory to development of the \u201cFunctional Muscle-Bone-Unit\u201d","volume":"5","author":"Schoenau","year":"2005"},{"key":"b27-spine13627","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1097\/01.brs.0000145412.93407.c3","article-title":"Results of surgical treatment for degenerative cervical myelopathy: anterior cervical corpectomy and stabilization","volume":"29","author":"Sevki","year":"2004"},{"key":"b28-spine13627","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1016\/j.jbiomech.2004.06.013","article-title":"Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading","volume":"38","author":"Stemper","year":"2005"},{"key":"b29-spine13627","series-title":"Calcif Tissue Int","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s00223-006-0041-3","article-title":"Genetic and environmental correlations between bone geometric parameters and body compositions","volume":"79","author":"Sun","year":"2006"},{"key":"b30-spine13627","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s00701-011-1229-5","article-title":"Evaluation of pain as a preference-based health status measure in patients with cervical spondylotic myelopathy undergoing central corpectomy","volume":"154","author":"Thakar","year":"2012"},{"key":"b31-spine13627","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"158","DOI":"10.3171\/SPI\/2008\/9\/8\/158","article-title":"Correlation between change in graft height and change in segmental angle following central corpectomy for cervical spondylotic myelopathy","volume":"9","author":"Thakar","year":"2008"},{"key":"b32-spine13627","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"660","DOI":"10.3171\/2011.8.SPINE11452","article-title":"Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy. Clinical article","volume":"15","author":"Vedantam","year":"2011"},{"key":"b33-spine13627","series-title":"Australas Phys Eng Sci Med","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s13246-013-0182-4","article-title":"Straightened cervical lordosis causes stress concentration: a finite element model study","volume":"36","author":"Wei","year":"2013"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/21\/2\/article-p223.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/21\/2\/article-p223.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/21\/2\/article-p223.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T23:04:00Z","timestamp":1681599840000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/21\/2\/article-p223.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,8]]},"references-count":33,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2014.4.spine13627","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2014,8]]}}}