Anterior cervical bridging osteophytes as a simple radiographic tool to assess severe fatty infiltration in the cervical extensor muscles.

Abstract

Fatty infiltration of the cervical extensor muscles is a key indicator of cervical sarcopenia and dysfunction, linked to poor clinical outcomes. Anterior cervical bridging osteophytes (ACBO) are a common radiographic feature of degeneration, potentially reflecting spinal instability; however, their relationship with cervical extensor muscles fatty infiltration remains underexplored. This study aimed to investigate the association between ACBO and severe fatty infiltration of cervical extensor muscles, and to evaluate the predictive value of ACBO for severe fatty infiltration. A retrospective study was conducted on 360 patients with cervical degenerative disease. Fatty infiltration of cervical extensor muscles was assessed on T2-weighted MRI using the Goutallier classification, with severe fatty infiltration defined as a grade ≥2.5. ACBO were identified and counted on lateral cervical radiographs. Demographic and imaging characteristics, including sagittal alignment and retrolisthesis, were also collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of severe fatty infiltration. Multicollinearity was assessed using variance inflation factor (VIF). Receiver operating characteristic (ROC) curve analysis assessed the predictive performance of significant factors. Patients with severe fatty infiltration (Group B, n = 189) were significantly older and had higher ACBO counts compared to those with non-severe fatty infiltration (Group A, n = 171). Multivariate analysis identified age (OR = 1.068, 95% CI: 1.037-1.101, p < 0.001), ACBO counts (OR = 2.458, 95% CI: 1.816-3.328, p < 0.001), and the presence of retrolisthesis (OR = 2.205, 95% CI: 1.247-3.897, p = 0.007) as independent predictors of severe fatty infiltration. ROC analysis demonstrated that ACBO counts (AUC = 0.719) and age (AUC = 0.722) had strong predictive value. The quantity of ACBO is a reliable and simple tool to assess severe fatty infiltration in the cervical extensor muscles. Combined with age and retrolisthesis, ACBO count provides a readily and applicable accessible radiographic tool for risk stratification, clinical decision-making, and prognostic assessment in degenerative cervical spine conditions.