Geniohyoid Muscle Size Is Associated With Respiratory Complications After Surgical Treatment for Traumatic Cervical Spinal Cord Injury.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42309228.
- Also identified by DOI 10.1016/j.spinee.2026.05.011.
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Abstract
Respiratory complications are common after traumatic cervical spinal cord injury (cSCI) and adversely affect early clinical outcomes. However, objective imaging-derived markers reflecting swallowing musculature reserve remain poorly studied in acute trauma. To determine whether geniohyoid muscle size on admission cervical computed tomography (CT) is associated with 30-day respiratory complications after surgery for traumatic cSCI. Retrospective single-center cohort study. 337 consecutive adults undergoing surgical decompression and/or stabilization for traumatic cSCI (2011-2024). 30-day respiratory complications, defined as pneumonia, prolonged ventilation (>72 h), or reintubation after planned extubation. Geniohyoid muscle cross-sectional area (GH-CSA) was measured on mid-sagittal admission CT by two independent assessors. Firth penalized logistic regression was used, adjusting for prespecified demographic, neurological, comorbidity, injury-related, and surgical covariates. Incremental predictive value was assessed by comparing model performance with and without GH-CSA. Respiratory complications occurred in 78/337 patients (23.1%). Lower GH-CSA was independently associated with higher odds of respiratory complications (adjusted odds ratio, 2.29 per 0.5-cm² decrease; 95% confidence interval [CI], 1.86-2.99; p<0.0001). The final model showed good discrimination (area under the curve [AUC], 0.86; 95% CI, 0.82-0.91). Adding GH-CSA to American Society of Anesthesiologists class, American Spinal Injury Association Impairment Scale grade, and posterior spinal fusion improved discrimination (ΔAUC, +0.11). Smaller geniohyoid muscle size on admission CT was independently associated with 30-day respiratory complications after surgery for traumatic cSCI. This marker may provide prognostic information beyond established predictors. External validation and prospective studies incorporating standardized swallowing assessment are warranted.