Spine Journal - 2026-06-17 - Journal Article
Geniohyoid Muscle Size Is Associated With Respiratory Complications After Surgical Treatment for Traumatic Cervical Spinal Cord Injury.
Murata S, Nagata K, Ishimoto Y, Teraguchi M, Hashizume H, Iwasaki H, Tsutsui S, Takami M, Murakami K, Kozaki T, Nakanishi R, Yamamoto Y, Murai K, Inoue S, Yamada H
Topics
Key Takeaway
Each 0.5-cm² decrease in geniohyoid muscle cross-sectional area on admission CT independently increased odds of 30-day respiratory complications by 2.29-fold (AUC 0.86) in 337 surgical cSCI patients.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether geniohyoid muscle cross-sectional area (GH-CSA) on admission CT predicts 30-day respiratory complications after surgical cSCI. In 337 consecutive patients, respiratory complications occurred in 23.1%; Firth penalized logistic regression showed smaller GH-CSA independently predicted complications (aOR 2.29 per 0.5-cm² decrease, 95% CI 1.86–2.99). Adding GH-CSA to a baseline model of ASA class, AIS grade, and posterior fusion improved AUC by +0.11, reaching 0.86.
Key Limitation
External validation is absent; a single-center cohort from 2011–2024 may reflect institution-specific ventilator weaning and extubation protocols that limit generalizability of the 23.1% complication rate and model thresholds.
Original Abstract
BACKGROUND CONTEXT
Respiratory complications are common after traumatic cervical spinal cord injury (cSCI) and adversely affect early clinical outcomes. However, objective imaging-derived markers reflecting swallowing musculature reserve remain poorly studied in acute trauma.
PURPOSE
To determine whether geniohyoid muscle size on admission cervical computed tomography (CT) is associated with 30-day respiratory complications after surgery for traumatic cSCI.
DESIGN
Retrospective single-center cohort study.
PATIENT SAMPLE
337 consecutive adults undergoing surgical decompression and/or stabilization for traumatic cSCI (2011-2024).
OUTCOME MEASURES
30-day respiratory complications, defined as pneumonia, prolonged ventilation (>72 h), or reintubation after planned extubation.
METHODS
Geniohyoid muscle cross-sectional area (GH-CSA) was measured on mid-sagittal admission CT by two independent assessors. Firth penalized logistic regression was used, adjusting for prespecified demographic, neurological, comorbidity, injury-related, and surgical covariates. Incremental predictive value was assessed by comparing model performance with and without GH-CSA.
RESULTS
Respiratory complications occurred in 78/337 patients (23.1%). Lower GH-CSA was independently associated with higher odds of respiratory complications (adjusted odds ratio, 2.29 per 0.5-cm² decrease; 95% confidence interval [CI], 1.86-2.99; p<0.0001). The final model showed good discrimination (area under the curve [AUC], 0.86; 95% CI, 0.82-0.91). Adding GH-CSA to American Society of Anesthesiologists class, American Spinal Injury Association Impairment Scale grade, and posterior spinal fusion improved discrimination (ΔAUC, +0.11).
CONCLUSIONS
Smaller geniohyoid muscle size on admission CT was independently associated with 30-day respiratory complications after surgery for traumatic cSCI. This marker may provide prognostic information beyond established predictors. External validation and prospective studies incorporating standardized swallowing assessment are warranted.