Is there cervical spine muscle weakness in patients with Hirayama disease? A morphological study about cross-sectional areas of muscles on MRI

  • Zhechen Li
  • Wenming Zhang
  • Wence Wu
  • Chao Wei
  • Xuanwei Chen
  • Jianhua LinEmail author
Original Article



Patients with Hirayama disease (HD) present with a larger range of neck flexion and show signs of cervical spine instability. Cervical spine stability largely relies on cervical spine muscles. The purpose of this study was to compare the cross-sectional areas (CSAs) of cervical spine muscles between patients with HD and healthy controls, providing some insights into whether there is cervical spine muscle weakness and incongruence in HD patients.


In this retrospective study, cervical spine muscles CSAs of 44 HD patients, as well as that of 44 age- and sex-matched healthy counterparts, were measured on the T2-weighted axial MR images. The ratios of cervical spine muscles CSA to the corresponding vertebral body areas, defined as R-CSAs, and the flexor/extensor CSA ratios were computed and compared between two groups.


Compared with healthy counterparts, R-CSAs of total cervical spine muscles, total extensors, superficial extensors, and deep flexors were significantly lower in HD patients. HD patients also demonstrated a significantly greater superficial flexor/superficial extensor CSA ratio than the healthy counterparts, indicating a mismatch between superficial flexors CSA and superficial extensors CSA in HD patients.


In this pioneering study, HD patients had decreased size in most cervical spine muscles and a mismatch between CSAs of superficial flexor and that of superficial extensors. These results indicate generalized weakness and incongruence of cervical spine muscles, which may predispose cervical spine of HD patients to a less stable situation.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Cervical spine Muscle Cross-sectional area MRI Hirayama disease 



Body mass index


Cross-sectional area


Deep extensors


Deep flexors


Hirayama disease


Magnetic resonance imagine


Relative cross-sectional area


Region of interest


Superficial extensors


Superficial flexor


Total extensors


Total flexors


Total cervical spine muscles


Vertebral body area



We thank the support from colleagues in our department. Our special thanks go to Dr. Eric Rebich, from Harborview Medical Center, University of Washington, Seattle, USA, for providing language help. We also appreciate the grant from the Startup Fund for scientific research, Fujian Medical University (2018QH1072).


This study was supported by a grant from Startup Fund for scientific research, Fujian Medical University (2018QH1072).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2020_6290_MOESM1_ESM.pptx (141 kb)
Supplementary file1 (PPTX 141 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Zhechen Li
    • 1
  • Wenming Zhang
    • 2
  • Wence Wu
    • 3
  • Chao Wei
    • 1
  • Xuanwei Chen
    • 1
  • Jianhua Lin
    • 1
    Email author
  1. 1.Department of Spine SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
  2. 2.Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
  3. 3.Fujian Medical UniversityFuzhouChina

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