Mri-based assessment of cervical muscle morphology in women with disc herniation: A retrospective case-control study

OBJECTIVE: To characterize subsystem-specific cervical muscle remodeling patterns and their clinical correlations in female patients with CDH. METHODS: A total of 130 patients with CDH who met the inclusion criteria and 60 patients with normal cervical spine MRI were screened. There were no statistically significant differences in gender, age and BMI between the CDH group and the cervical spine MRI-normal group. Cross-sectional areas (CSA) of seven cervical muscles were quantified at C4-5, C5-6, and C6-7 levels, categorized into: Deep stabilizers, Transitional coordinators and Superficial mobilizers. Analyses assessed associations between muscle CSA, disease duration, pain severity, disc degeneration grade and type of herniation, among others. RESULTS: Compared with the MRI-normal group, the CSA of deep stabilizers in CDH group was smaller, while the CSA of transitional modulators and superficial dynamic system were larger. In different disc herniation grading, the deep stabilizers in herniated disc group were smaller than that in bulging disc group, while transitional modulators and superficial dynamic system were larger. The pain score, duration of disease and age of CDH group were negatively correlated with deep stabilizers but positively correlated with superficial dynamic system. CONCLUSION: CDH in women is linked to a distinct change in cervical muscle morphology, which suggests a hypothetical model of hierarchical muscular adaptation in CDH, characterized by atrophy of the deep stabilizers, hypertrophy of the transitional modulators, and hypertrophy of the superficial muscles. Prospective longitudinal studies are warranted to validate this conceptual framework and to determine its clinical implications.