39. Does cervical paraspinal muscle degeneration influence quality of life after cervical spine surgery?

Abstract

BACKGROUND CONTEXT

Recent studies have highlighted the impact of fatty degeneration in paraspinal muscles on quality of life (QOL), yet its role in the cervical spine remains unclear.

PURPOSE

This study aimed to identify factors related to QOL improvement two years following cervical laminoplasty for degenerative cervical myelopathy (DCM), using the Minimum Clinically Important Difference (MCID) in the EuroQOL 5 Dimensions 5-Level (EQ-5D-5l) as a measure of significant change.

STUDY DESIGN/SETTING

Multicenter, retrospective study.

PATIENT SAMPLE

This study included 111 patients (mean age 72.8 years, 47 women) who underwent laminoplasty for DCM from February 2019.

OUTCOME MEASURES

Clinical outcomes were assessed using EQ-5D-5l, Japanese Orthopaedic Association (JOA) scores, and Visual Analog Scale (VAS) scores for neck pain, upper extremity pain, and numbness. Radiographic parameters, including C2-C7 sagittal vertical axis (SVA), C2-C7 kyphosis angle, and C7 slope, were evaluated preoperatively and at the two-year follow-up. MRI assessed fatty degeneration and cross-sectional area of cervical paraspinal muscles (superficial and deep) at the C3, C5, and C7 levels at 2 years postoperatively.

METHODS

The MCID cutoff for EQ-5D-5l, set at 0.0485 based on previous reports, was used to classify patients into a Poor recovery group and a Control group. Mann-Whitney U tests were used as a univariate analysis to compare the two groups. Logistic regression analysis was conducted for variables significant in univariate analysis, adjusting for age, gender, and preoperative EQ-5D-5l.

RESULTS

Comparing 34 patients in the Poor recovery group and 77 in the Control group, significant differences were observed in preoperative EQ-5D-5l (0.91 vs. 0.58, p< 0.001) and preoperative VAS for neck pain (19.2 vs. 34.6, p=0.017). Postoperatively, significant differences were noted in deep muscle fatty degeneration at the C7 level (56% vs. 49%, p=0.029) and cross-sectional areas of deep fat at C7 (2.6 vs. 2.2, p=0.006) and C3 (2.1 vs. 1.7, p=0.048). Logistic regression analysis, adjusted for age, gender, and preoperative EQ-5D-5l, identified deep muscle fatty degeneration at the C7 level as an independent factor associated with achieving MCID (adjusted odds ratio 0.97, p=0.045).

CONCLUSIONS

Our findings suggest that cervical paraspinal muscle degeneration at the C3 and C7 levels may be linked to QOL improvements following cervical laminoplasty. Deep muscle fatty degeneration particularly at the C7 level, was identified as an important factor for postoperative imaging evaluation, highlighting its potential as a predictive marker for patient-reported outcome gains.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.