Cervical Paraspinal Muscle Fatty Infiltration as a Marker of Frailty and Predictor of Perioperative Outcomes in Posterior Cervical Decompression and Fusion

The purpose of this study was to evaluate the role of cervical paraspinal muscle fatty infiltration as a marker of frailty and as a predictor of perioperative outcomes among patients undergoing posterior cervical decompression and fusion (PCDF) for cervical degenerative disease.

A retrospective review was performed of patients older than 50 years undergoing primary multi-level PCDF for degenerative etiologies between 2021 and 2024 at a single tertiary care institution. Paraspinal muscle fatty infiltration was graded using preoperative T2-weighted axial magnetic resonance imaging at the C5-C6 level according to the Goutallier classification. Cohorts were analyzed individually and stratified into two groups: Low (scores 0–2) and High (scores 3–4) fatty infiltration. Frailty was concurrently assessed using the Modified Frailty Index-5 (MFI-5). Relationships between demographics, MFI-5, Goutallier scores, and postoperative outcomes were analyzed using chi-squared analyses, Fisher's exact test, analysis of variance, and multivariable logistic and linear regression.

A total of 128 patients were included, with a mean age of 67.0 ± 8.5 years, 51.6% female, and a mean MFI-5 score of 1.7 ± 1.0. Higher individual Goutallier scores were associated with older age (p = 0.039), lower BMI (p = 0.002), lower HbA1c (p = 0.037), and significant differences in racial distribution, with higher proportions of White patients (p = 0.001) and lower proportions of African American patients (p = 0.003), without a significant difference in MFI-5 scores across groups (p = 0.618). No significant differences in surgical time, length of stay, discharge disposition, 180-day complication rates, or reoperation rates were observed; however, a trend toward increased readmission rates was noted (p = 0.052). Following Goutallier stratification, lower BMI (p = 0.014) and a similar racial distribution for White (p = 0.003) and African American (p = 0.005) patients persisted, again without a significant association with MFI-5 scores (p = 0.777). The High Goutallier cohort was associated with a statistically significant increased risk of 180-day readmission (p = 0.022), without significant differences in surgical time, length of stay, discharge disposition, complication rates, or reoperation rates.

Higher degrees of paraspinal muscle fatty infiltration are associated with increased 180-day readmission following PCDF. These findings suggest that preoperative MRI assessment of paraspinal muscle quality may serve as a clinically useful tool for risk stratification and surgical planning in patients undergoing posterior instrumented treatment for cervical degenerative disease.