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
A total of 101 patients were included (mild: n = 45; moderate: n = 38; severe: n = 18). Baseline characteristics were comparable among groups. Postoperative drainage volume was higher in the moderate (153.4 ± 45.2 mL) and severe groups (145.6 ± 79.5 mL) than in the mild group (99.9 ± 67.4 mL; p = 0.001), with longer hospital stay (p = 0.042). At 12 months, the severe group showed lower JOA scores (11.95 ± 3.87 vs. 14.69 ± 2.58), reduced JOA recovery rates (55.9%±26.5% vs. 68.3%±23.7%), and lower MCID achievement for JOA and NDI (all p < 0.05). Greater loss of cervical lordosis was observed in the severe group (C2-C7 Cobb angle: 3.57 ± 9.62° vs. 7.34 ± 9.80°; p < 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.