Geniohyoid muscle size is associated with respiratory complications after surgical treatment for traumatic cervical spinal cord injury.

BACKGROUND CONTEXT: 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.

PURPOSE: To determine whether geniohyoid muscle size on admission cervical computed tomography (CT) is associated with 30-day respiratory complications after surgery for traumatic cSCI.

DESIGN

Retrospective single-center cohort study.

PATIENT SAMPLE: A total of 337 consecutive adults undergoing surgical decompression and/or stabilization for traumatic cSCI (2011-2024).

OUTCOME MEASURES: A total of 30-day respiratory complications, defined as pneumonia, prolonged ventilation (>72 hours), or reintubation after planned extubation.

METHODS

Geniohyoid muscle cross-sectional area (GH-CSA) was measured on midsagittal admission CT by 2 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.

RESULTS

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, 1.86-2.99; p<.0001). The final model showed good discrimination (area under the curve [AUC], 0.86; 95% confidence interval, 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).

CONCLUSIONS

Smaller GH 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.