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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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
Pages (from-to)931-935
Number of pages5
JournalGlobal Spine Journal
Issue number6
StatePublished - Jul 2021
Externally publishedYes


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


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