Cervical Paraspinal Muscle Parameters are Associated With Bone Mineral Density as Measured by Quantitative Computed Tomography and Vertebral Bone Quality in Preoperative Patients

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.