Spine - 2026-04-21 - Journal Article
Cervical Paraspinal Muscle Parameters are Associated With Bone Mineral Density as Measured by Quantitative Computed Tomography and Vertebral Bone Quality in Preoperative Patients.
Verna B, Arzani A, Caffard T, Schonnagel L, Nathoo I, Finos K, Camino-Willhuber G, Amoroso K, Chiapparelli E, Zhu J, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP
Topics
Key Takeaway
In 100 preoperative ACDF patients, anterior cervical paraspinal muscle fat infiltration positively associated with VBQ scores (worse bone quality) across C2–T1, while posteromedial CSA positively associated with vBMD at C1 and C3 on QCT.
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Summary
This study examined whether cervical paraspinal muscle morphology at C3 correlates with site-specific bone quality in 100 preoperative ACDF patients using QCT-derived vBMD and MRI-derived VBQ scores. Multivariable regression adjusted for age, sex, and BMI with Benjamini-Hochberg correction showed anterior group fCSA negatively associated and fat infiltration positively associated with VBQ across C2–T1; posteromedial CSA positively associated with vBMD at C1 and C3. These findings suggest cervical muscle composition on routine preoperative imaging may serve as a surrogate marker for cervical bone quality without additional dedicated bone density testing.
Key Limitation
The study is cross-sectional with n=100 from a single institution, preventing determination of whether cervical muscle degeneration precedes or follows bone quality loss, and underpowered to detect level-specific associations across all cervical segments.
Original Abstract
STUDY DESING
Retrospective cohort study.
OBJECTIVE
To characterize the association between paraspinal musculature at C3 and cervical volumetric bone mineral density (vBMD) derived from quantitative computed tomography (QCT) and vertebral bone quality (VBQ) scores from magnetic resonance imaging (MRI).
SUMMARY OF BACKGROUND DATA
Osteoporosis and sarcopenia are prevalent among elderly patients and often coexist. Prior studies have shown a positive association between lumbar paraspinal functional cross-sectional area (fCSA) and bone mineral density, but the relationship between cervical paraspinal muscles and cervical bone quality remains unclear. Although dual-energy X-ray absorptiometry (DEXA) is the clinical gold standard for assessing bone density, newer modalities such as QCT and VBQ can evaluate site-specific bone health. Understanding this muscle-bone relationship in the cervical spine may improve preoperative risk stratification and surgical planning.
METHODS
Patients with preoperative cervical MRI and CT who underwent anterior cervical discectomy and fusion between 2015 and 2018 were reviewed. Muscles at C3 were categorized into four functional groups: sternocleidomastoid, anterior, posteromedial, and posterolateral. For all groups, cross-sectional area (CSA), fCSA, and fat infiltration (FI) were measured. QCT and VBQ analyses were performed using established methodologies. Multivariable linear regression adjusted for age, sex, and body mass index (BMI) and Benjamini-Hochberg correction were performed.
RESULTS
A total of 100 patients (median age, 56.5 years; 38 females) were included. After adjusting, regression analyses demonstrated a significant negative association between fCSA of the anterior group and VBQ scores from C2 to T1, as well as a significant positive association between FI of the same group and VBQ scores. Additionally, a significant positive association was observed between CSA of the posteromedial group and vBMD at C1 and C3.
CONCLUSION
Significant associations were observed between cervical paraspinal muscle morphology and vertebral bone quality and density measured using VBQ and QCT, respectively.