Higher Paraspinal Muscle Density Effect on Outcomes After Anterior Cervical Discectomy and Fusion

Zachariah W. Pinter, Scott C. Wagner, Donald R. Fredericks, Ashley Xiong, Brett A. Freedman, Benjamin D. Elder, Ahmad Nassr, Mohamad Bydon, Christopher K. Kepler, Arjun S. Sebastian

Research output: Contribution to journalArticlepeer-review


Study Design: Retrospective cohort study. Objectives: Studies in the lumbar spine suggest a correlation between sarcopenia and worse patient outcomes. The purpose of this study was to determine whether paraspinal Goutalier grade of fat degeneration is associated with patient-reported outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: We performed a retrospective review of a prospective cohort of patients undergoing 1- to 3-level ACDF at a single institution between the years 2011-2014. We utilized preoperative magnetic resonance images to classify patients into Goutalier grades. Patient-reported outcomes, including Neck Disability Index (NDI), RAND score, and EQ-5D score were collected and analyzed according to patients’ Goutalier grade. Results: We identified 69 patients for inclusion. A total of 29 patients were classified as Goutalier 0-1 (group 1), 29 were Goutalier 1.5-2 (group 2), and 11 were Goutalier 2.5-4.0 (group 3). All Goutalier groups experienced significant improvement in all 3 outcome scores. Average postoperative NDI scores were 25.3 in group 1, 13.9 in group 2, and 25.1 in group 3 (P =.02). The percentage of patients in each group reporting worse disability after surgery was 17.2%, 3.3%, and 9.1%, respectively (P =.05). No statistically significant difference was seen between groups in postoperative EQ-5D (P =.07) or RAND scores (P >.05). Conclusions: The present study is the first to assess the association between cervical paraspinal muscle Goutalier grade and patient-reported outcomes following ACDF. Based on our study, patients with worse cervical paraspinal degeneration may benefit from improved symptom relief in comparison to patients with a lesser degree of degeneration undergoing ACDF.

Original languageEnglish (US)
Pages (from-to)931-935
Number of pages5
JournalGlobal Spine Journal
Issue number6
StatePublished - Jul 2021


  • ACDF
  • Goutalier grade
  • anterior cervical discectomy and fusion
  • paraspinal muscle
  • sarcopenia

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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