Abstract
Background/Objectives: Paraspinal muscles are important for maintaining cervical spine function and stability; however, the degeneration of these muscles is common in patients with degenerative disk disease. Such muscular changes may affect recovery trajectories and long-term functional outcomes after cervical spine surgery. This systematic review explores the existing literature on the relationship between the degree of paraspinal muscle degradation and functional outcomes following anterior cervical spine surgery in patients with cervical degenerative disk disease. Methods: A systematic review of the MEDLINE/Pubmed, Web of Science, and Embase databases was conducted according to the PRISMA guidelines up to June 2025. The inclusion criteria were patients who underwent surgery for cervical degenerative disk disease and assessments of the paraspinal muscles with magnetic resonance imaging. The methodological quality of the included studies was assessed using the Modified Newcastle-Ottawa Scale. Results: Following deduplication, a total of 3643 articles were screened, of which 6 met the inclusion criteria and were included in the review. Across these studies, a total of 515 patients were followed for at least one year. Two studies reported a negative association between paraspinal muscle degeneration and functional outcomes, three reported no association, and one reported a positive association. Conclusions: The available evidence on this topic is inconclusive. These mixed results highlight the need for further well-designed, adequately powered studies to clarify the relationship between paraspinal muscle degeneration and functional outcomes.