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Is there cervical spine muscle weakness in patients with Hirayama disease? A morphological study about cross-sectional areas of muscles on MRI

Abstract

Purpose

Patients with Hirayama disease (HD) present with a larger range of neck flexion and show signs of cervical spine instability. Cervical spine stability largely relies on cervical spine muscles. The purpose of this study was to compare the cross-sectional areas (CSAs) of cervical spine muscles between patients with HD and healthy controls, providing some insights into whether there is cervical spine muscle weakness and incongruence in HD patients.

Methods

In this retrospective study, cervical spine muscles CSAs of 44 HD patients, as well as that of 44 age- and sex-matched healthy counterparts, were measured on the T2-weighted axial MR images. The ratios of cervical spine muscles CSA to the corresponding vertebral body areas, defined as R-CSAs, and the flexor/extensor CSA ratios were computed and compared between two groups.

Results

Compared with healthy counterparts, R-CSAs of total cervical spine muscles, total extensors, superficial extensors, and deep flexors were significantly lower in HD patients. HD patients also demonstrated a significantly greater superficial flexor/superficial extensor CSA ratio than the healthy counterparts, indicating a mismatch between superficial flexors CSA and superficial extensors CSA in HD patients.

Conclusions

In this pioneering study, HD patients had decreased size in most cervical spine muscles and a mismatch between CSAs of superficial flexor and that of superficial extensors. These results indicate generalized weakness and incongruence of cervical spine muscles, which may predispose cervical spine of HD patients to a less stable situation.

Graphic abstract

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Fig. 1

Abbreviations

BMI:

Body mass index

CSA:

Cross-sectional area

DEs:

Deep extensors

DFs:

Deep flexors

HD:

Hirayama disease

MRI:

Magnetic resonance imagine

R-CSA:

Relative cross-sectional area

ROI:

Region of interest

SEs:

Superficial extensors

SF:

Superficial flexor

TEs:

Total extensors

TFs:

Total flexors

TCMs:

Total cervical spine muscles

VBA:

Vertebral body area

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Acknowledgements

We thank the support from colleagues in our department. Our special thanks go to Dr. Eric Rebich, from Harborview Medical Center, University of Washington, Seattle, USA, for providing language help. We also appreciate the grant from the Startup Fund for scientific research, Fujian Medical University (2018QH1072).

Funding

This study was supported by a grant from Startup Fund for scientific research, Fujian Medical University (2018QH1072).

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Correspondence to Jianhua Lin.

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Li, Z., Zhang, W., Wu, W. et al. Is there cervical spine muscle weakness in patients with Hirayama disease? A morphological study about cross-sectional areas of muscles on MRI. Eur Spine J (2020). https://doi.org/10.1007/s00586-020-06290-1

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Keywords

  • Cervical spine
  • Muscle
  • Cross-sectional area
  • MRI
  • Hirayama disease