Acta Neurochirurgica

, Volume 161, Issue 10, pp 2201–2209 | Cite as

Deep flexor sarcopenia as a predictor of poor functional outcome after anterior cervical discectomy in patients with myelopathy

  • Sumit ThakarEmail author
  • Aditya Atal Arun
  • Saritha Aryan
  • Dilip Mohan
  • Alangar S Hegde
Original Article - Spine degenerative
Part of the following topical collections:
  1. Spine degenerative



Paraspinal muscle morphometry has been recognized to be a prognostic factor across various surgical conditions, but its utility in predicting disease-specific outcomes in spine surgery remains under-explored.


A prospective cohort study was performed on 45 consecutive patients undergoing anterior cervical discectomy (ACD) for single-level, symptomatic cervical degenerative disc disease causing radiculomyelopathy or myelopathy. Previously described predictors of outcome such as age, gender, smoking, comorbidities, duration of symptoms, preoperative Nurick grade, extent of cord compression, and signal intensity change in the cord were recorded. Additionally, MRI-based morphometrics of the superficial and deep paraspinal muscles were recorded. Logistic regression (LR) analysis was performed using a purposeful variable selection process to identify variables that independently predicted Nurick grade improvement (NGI).


At a mean follow-up of 20.02 ± 8.63 months after ACD, 37 (82.22%) patients demonstrated NGI. LR analysis yielded three predictors of NGI of which two were related to the deep flexor muscles. While a worse preoperative Nurick grade negatively predicted NGI, a deep flexor area and deep flexor/deep extensor area ratio positively predicted NGI. The regression model demonstrated a good fit and was statistically significant (χ2(3) = 22.18, p < 0.0001). The model explained 64% of the variance in NGI and correctly classified 89% of cases.


This study has for the first time identified the utility of paraspinal morphometrics in predicting disease-specific functional outcome after cervical spine surgery. Our results indicate that in addition to preoperative Nurick grade, an already accepted outcome predictor, the deep flexor cross-sectional area, and the deep flexor/deep extensor ratio are strong predictors of NGI following ACD for single-level, symptomatic cervical degenerative disc disease with myelopathy. Deep muscle morphometrics could be included in future risk stratification algorithms for patients with cervical disc disease.


Paraspinal muscles Deep flexors Predictor Functional outcome Anterior cervical discectomy 



Anterior cervical discectomy


Anterior cervical discectomy with fusion


Anterior cervical discectomy with arthroplasty


Cross-sectional area


Computed tomography


Deep extensor


Deep flexor


Logistic regression


Magnetic resonance imaging


Nurick grade improvement


Ossified posterior longitudinal ligament


Paraspinal muscles


Region of interest


Superficial extensor


Superficial flexor


Vertebral body area


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

701_2019_3972_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurological SciencesSri Sathya Sai Institute of Higher Medical SciencesBangaloreIndia

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