Association between reduced cervical extensor muscle mass and postoperative outcomes after single-door laminoplasty in elderly patients with cervical spondylotic myelopathy: a retrospective study

BACKGROUND: To investigate the association between preoperative cervical extensor muscle fatty infiltration and postoperative clinical and radiographic outcomes after posterior open-door laminoplasty in elderly patients with cervical spondylotic myelopathy (CSM). METHODS: Elderly patients (>60 years) who underwent first-time posterior single-door laminoplasty for multilevel CSM between January 2015 and December 2020 were retrospectively reviewed. All patients had a minimum follow-up of 12 months. Fatty infiltration of cervical extensor muscles was assessed on preoperative MRI using the Goutallier grading system and classified as mild, moderate, or severe. Clinical outcomes (Japanese Orthopaedic Association [JOA] score, Neck Disability Index [NDI], Visual Analog Scale [VAS]), minimal clinically important difference (MCID), perioperative parameters, and cervical sagittal alignment were evaluated. RESULTS: < 0.001). CONCLUSION: Severe fatty infiltration of cervical extensor muscles is associated with poorer neurological recovery, prolonged hospitalization, and sagittal imbalance after laminoplasty in elderly CSM patients. Preoperative MRI-based muscle quality assessment may improve risk stratification and guide surgical planning and postoperative rehabilitation.