{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:21Z","timestamp":1787721621129,"version":"build-2784847793"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical spondylosis at C5\u20136 is common, but conventional imaging may not fully capture paraspinal muscle composition or posture-related segmental angular behavior. This study assessed layer-specific paraspinal muscle fat infiltration (FI) and cross-sectional area (CSA) on conventional MRI and examined their associations with C5\u20136 disc degeneration and posture-related angular change (PAC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cross-sectional study, 94 patients with single-level C5\u20136 cervical spondylosis who underwent cervical MRI and standing lateral radiography between January 2023 and December 2025 were included. At the C5\u20136 disc level, bilateral splenius capitis (SPL), semispinalis capitis (SCap), and combined multifidus plus semispinalis cervicis (MF\u2009+\u2009SCer) were manually segmented. FI was calculated as a semi-quantitative area percentage using a fixed 8-bit gray-level threshold (79\u2013255), and CSA was measured on calibrated axial T2-weighted images. PAC was defined as the absolute difference between standing radiographic and supine MRI local C5\u20136 Cobb angles; patients were classified as low-PAC\/relatively stiff (|PAC|\u2009\u2264\u20095\u00b0) or high-PAC\/relatively mobile (|PAC|\u2009&amp;gt;\u20095\u00b0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>FI in all three muscle groups increased with higher Pfirrmann grades, whereas CSA did not differ significantly across grades. Pfirrmann grade was independently associated with FI in the SPL, SCap, and MF\u2009+\u2009SCer after adjustment for age and sex. Compared with the high-PAC group, the low-PAC group showed higher FI in the SPL, SCap, and MF\u2009+\u2009SCer, and these differences remained significant after adjustment for age, sex, BMI, and Pfirrmann grade. CSA did not differ significantly between PAC phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with single-level C5\u20136 cervical spondylosis, paraspinal muscle alteration was characterized primarily by increased FI, whereas CSA reduction was not evident. Compared with CSA, semi-quantitative FI measured on conventional MRI may be more sensitive for detecting observable changes in muscle composition. Higher FI in the superficial and intermediate posterior extensor muscles was associated with a low-PAC\/relatively stiff phenotype. Combining PAC with paraspinal muscle FI may provide supplementary imaging information on segmental angular differences between weight-bearing and non-weight-bearing positions; however, the clinical relevance of this combined assessment requires prospective validation using quantitative fat imaging and clinical or functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1889821","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:44:12Z","timestamp":1787719452000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Semi-quantitative assessment of paraspinal muscle fat infiltration in single-level C5\u20136 cervical spondylosis using gray-level thresholding on conventional MRI: associations with disc degeneration and posture-related segmental angular change"],"prefix":"10.3389","volume":"13","author":[{"given":"Yifei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]},{"name":"Clinical Research Center for Spinal Deformity of Anhui Province","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiubo","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Lu","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Spinal Deformity of Anhui Province","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoran","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fuyang People\u2019s Hospital Affiliated to Anhui Medical University (Fuyang People\u2019s Hospital)","place":["Fuyang, Anhui, China"]},{"name":"Clinical Research Center for Spinal Deformity of Anhui Province","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1177\/2192568217719436","article-title":"Patterns of cervical disc degeneration: analysis of magnetic resonance imaging of over 1000 symptomatic subjects","volume":"8","author":"Suzuki","year":"2018","journal-title":"Global Spine J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2675","DOI":"10.1007\/s00586-022-07336-2","article-title":"Trends and patterns of cervical degenerative disc disease: an analysis of magnetic resonance imaging of 1300 symptomatic patients","volume":"31","author":"Mesregah","year":"2022","journal-title":"Eur Spine J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1038\/s41582-019-0303-0","article-title":"Degenerative cervical myelopathy\u2014update and future directions","volume":"16","author":"Badhiwala","year":"2020","journal-title":"Nat Rev Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"105862","DOI":"10.1016\/j.bas.2025.105862","article-title":"Cervical sagittal alignment and its impact on degenerative cervical myelopathy outcomes","volume":"5","author":"Molliqaj","year":"2025","journal-title":"Brain Spine"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1007\/s00586-025-08648-9","article-title":"The role of paraspinal muscle degeneration in cervical spondylosis","volume":"34","author":"Li","year":"2025","journal-title":"Eur Spine J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12891-018-2074-y","article-title":"Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II\u2014cervical spine musculature","volume":"19","author":"Elliott","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.msksp.2018.07.003","article-title":"Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy","volume":"38","author":"Fortin","year":"2018","journal-title":"Musculoskelet Sci Pract"},{"key":"B8","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/BRS.0000000000004897","article-title":"Association between cervical sagittal alignment and subaxial paraspinal muscle parameters","volume":"49","author":"Caffard","year":"2024","journal-title":"Spine"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1093\/pm\/pnad098","article-title":"Multifidus dysfunction and restorative neurostimulation: a scoping review","volume":"24","author":"Tieppo Francio","year":"2023","journal-title":"Pain Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1111\/os.12962","article-title":"Imaging evaluation of fat infiltration in paraspinal muscles on MRI: a systematic review with a focus on methodology","volume":"13","author":"Han","year":"2021","journal-title":"Orthop Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1301","DOI":"10.1002\/jsp2.1301","article-title":"Thresholding approaches for estimating paraspinal muscle fat infiltration using T1- and T2-weighted MRI: comparative analysis using water\u2013fat MRI","volume":"7","author":"Ornowski","year":"2024","journal-title":"JOR Spine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1186\/s13018-024-04935-1","article-title":"Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF","volume":"19","author":"Ma","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1186\/s12891-024-07808-0","article-title":"MRI-based assessment paraspinal extensor muscle fatty infiltration in acute cervical spinal cord injury patients\u2014a retrospective study","volume":"25","author":"Liao","year":"2024","journal-title":"BMC Musculoskeletal Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1209475","DOI":"10.3389\/fneur.2023.1209475","article-title":"Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes","volume":"14","author":"Naghdi","year":"2023","journal-title":"Front Neurol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"102056","DOI":"10.1016\/j.msksp.2019.102056","article-title":"Reliability of cervical muscle volume quantification using magnetic resonance imaging","volume":"44","author":"Snodgrass","year":"2019","journal-title":"Musculoskelet Sci Pract"},{"key":"B16","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1097\/CORR.0000000000001621","article-title":"Cervical paraspinal muscle fatty degeneration is not associated with muscle cross-sectional area: qualitative assessment is preferable for cervical sarcopenia","volume":"479","author":"Pinter","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1128810","DOI":"10.3389\/fendo.2023.1128810","article-title":"The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: a controlled study based on hybrid surgery","volume":"14","author":"He","year":"2023","journal-title":"Front Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1007\/s00586-021-06833-0","article-title":"Correlation of supine MRI and standing radiographs for cervical sagittal balance in myelopathy patients: a cross-sectional study","volume":"30","author":"Boudreau","year":"2021","journal-title":"Eur Spine J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1038\/s41393-023-00895-1","article-title":"Correlation and reliability of cervical sagittal alignment parameters between plain radiographs and multipositional MRI images","volume":"61","author":"Zhou","year":"2023","journal-title":"Spinal Cord"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1007\/s00586-017-5306-1","article-title":"Can multi-positional magnetic resonance imaging be used to evaluate angular parameters in cervical spine? A comparison of multi-positional MRI to dynamic plain radiograph","volume":"27","author":"Paholpak","year":"2018","journal-title":"Eur Spine J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s13018-024-04542-0","article-title":"Odontoid incidence: a constant cervical anatomical feature evident in standing plain radiographs and supine magnetic resonance images","volume":"19","author":"Huang","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.3390\/medicina61091654","article-title":"Comparison of radiography with computed tomography and magnetic resonance imaging in the measurement of cervical lordosis","volume":"61","author":"Sevin","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1016\/j.spinee.2025.01.037","article-title":"The influence of body posture on cervical alignment measured in the sagittal plane on conventional radiographs: a systematic review","volume":"25","author":"van Santbrink","year":"2025","journal-title":"Spine J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1097\/00007632-200109010-00011","article-title":"Magnetic resonance classification of lumbar intervertebral disc degeneration","volume":"26","author":"Pfirrmann","year":"2001","journal-title":"Spine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e87856","DOI":"10.1371\/journal.pone.0087856","article-title":"Quantitative T2 magnetic resonance imaging compared to morphological grading of the early cervical intervertebral disc degeneration: an evaluation approach in asymptomatic young adults","volume":"9","author":"Chen","year":"2014","journal-title":"PLoS One"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e4502","DOI":"10.1097\/MD.0000000000004502","article-title":"Correlation between T2* (T2 star) relaxation time and cervical intervertebral disc degeneration","volume":"95","author":"Huang","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1281506","DOI":"10.3389\/fphys.2023.1281506","article-title":"MRI radiomics-based decision support tool for a personalized classification of cervical disc degeneration: a two-center study","volume":"14","author":"Xie","year":"2024","journal-title":"Front Physiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1016\/j.spinee.2024.11.017","article-title":"Quantitative assessment of cervical disc degeneration using disc signal intensity index","volume":"25","author":"Tsuchiya","year":"2025","journal-title":"Spine J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"169","DOI":"10.31616\/asj.2019.0069","article-title":"Accuracy and reliability of x-ray measurements in the cervical spine","volume":"14","author":"Marques","year":"2020","journal-title":"Asian Spine J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1037\/0033-2909.86.2.420","article-title":"Intraclass correlations: uses in assessing rater reliability","volume":"86","author":"Shrout","year":"1979","journal-title":"Psychol Bull"},{"key":"B32","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1037\/h0031619","article-title":"Measuring nominal scale agreement among many raters","volume":"76","author":"Fleiss","year":"1971","journal-title":"Psychol Bull"},{"key":"B33","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","journal-title":"Biometrics"},{"key":"B34","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1148\/radiol.2282011860","article-title":"Measurement of observer agreement","volume":"228","author":"Kundel","year":"2003","journal-title":"Radiology"},{"key":"B35","doi-asserted-by":"publisher","first-page":"E22","DOI":"10.1097\/BSD.0000000000001356","article-title":"Cervical paraspinal muscle fatty infiltration is directly related to extension reserve in patients with cervical spine pathology","volume":"36","author":"Virk","year":"2023","journal-title":"Clin Spine Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1016\/j.wneu.2021.12.041","article-title":"Association between muscle morphology changes, cervical spine degeneration, and clinical features in patients with chronic nonspecific neck pain: a magnetic resonance imaging analysis","volume":"159","author":"Huang","year":"2022","journal-title":"World Neurosurg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1186\/s12891-023-06595-4","article-title":"Fatty infiltration of the cervical multifidus musculature and its clinical correlation to cervical spondylosis","volume":"24","author":"Li","year":"2023","journal-title":"BMC Musculoskeletal Disord"},{"key":"B38","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3171\/2024.2.SPINE23926","article-title":"Importance of the cervical paraspinal muscles in postoperative patient-reported outcomes and maintenance of sagittal alignment after anterior cervical discectomy and fusion","volume":"41","author":"Caffard","year":"2024","journal-title":"J Neurosurg Spine"},{"key":"B39","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1186\/s12891-022-05606-0","article-title":"Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?","volume":"23","author":"Wang","year":"2022","journal-title":"BMC Musculoskeletal Disord"},{"key":"B40","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1038\/s41584-022-00888-z","article-title":"Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum","volume":"19","author":"Fine","year":"2023","journal-title":"Nat Rev Rheumatol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.semcdb.2021.07.013","article-title":"Fibro-Adipogenic progenitors: versatile keepers of skeletal muscle homeostasis, beyond the response to myotrauma","volume":"119","author":"Wei","year":"2021","journal-title":"Semin Cell Dev Biol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1038\/s41556-018-0151-y","article-title":"Denervation-activated STAT3\u2013IL-6 signalling in fibro-adipogenic progenitors promotes myofibres atrophy and fibrosis","volume":"20","author":"Madaro","year":"2018","journal-title":"Nat Cell Biol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"5585","DOI":"10.3390\/ijms24065585","article-title":"Denervation drives YAP\/TAZ activation in muscular fibro\/adipogenic progenitors","volume":"24","author":"Gallardo","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B44","doi-asserted-by":"publisher","first-page":"12691","DOI":"10.1096\/fj.202000506R","article-title":"mir-22-3p\/KLF6\/MMP14 axis in fibro-adipogenic progenitors regulates fatty infiltration in muscle degeneration","volume":"34","author":"Lin","year":"2020","journal-title":"FASEB J"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889821\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:44:26Z","timestamp":1787719466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889821\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":44,"alternative-id":["10.3389\/fmed.2026.1889821"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1889821","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1889821"}}