The participants in this study were those who were already alive when the data was collected. The plan all along was, as far as researchers were aware, this was the first study to evaluate the effects of paraspinal sarcopenia on patient-reported outcome measures (PROMs) after posterior cervical decompression and fusion (PCDF). Sarcopenia has been shown to negatively affect patient-reported outcomes after lumbar spine surgery; however, its effect on PROMs after PCDF has not been studied. Researchers looked back at all C2-T2 PCDF surgeries done at a single hospital between 2017 and 2020. Fat infiltration of the bilateral multifidus muscles at the C5-C6 level was evaluated using axial cuts of T2-weighted magnetic resonance imaging sequences, and patients were classified using the Fuchs Modification of the Goutalier grading system by 2 independent reviewers who were blinded to the clinical outcome scores. Then, they compared PROMs across different categories. They included a total of 99 patients, including 28 with mild sarcopenia, 45 with moderate sarcopenia, and 26 with severe sarcopenia. In terms of preoperative PROM, there was no significant variation across the groups. However, both the mild and moderate sarcopenia subgroups had lower mean postoperative Neck Disability Index scores (12.8 and 13.4, respectively, P<0.001) than the severe sarcopenia cohort (21.0). Postoperatively, more patients with severe multifidus sarcopenia reported worsening of the Neck Disability Index (10 patients, 38.5%; P=0.003), Visual Analog Scale Neck scores (7 patients, 26.9%; P=0.02), Patient-Reported Outcome Measurement Information System Physical Component Scores (10 patients, 38.5%; P=0.02), and Patient-Reported Outcome Measurement Information System Mental Component Scores (14 patients, 53.8%; P=Less improvement is shown in neck impairment and physical function postoperatively in patients with more severe paraspinal sarcopenia, and patients with more severe sarcopenia are also significantly more likely to report worsening PROMs).