Complications after Posterior Lumbar Fusion for Degenerative Disc Disease: Sarcopenia and Osteopenia as Independent Risk Factors for Infection and Proximal Junctional Disease

Abstract

Proximal Junctional Disease (PJD) and Surgical Site Infection (SSI) are among the most common complications following spine surgery. Their risk factors are not fully understood. Among them, sarcopenia and osteopenia have recently been attracting interest. The aim of this study is to evaluate their influence on mechanical or infective complications after lumbar spine fusion. Patients who underwent open posterior lumbar fusion were analyzed. Through preoperative MRI, central sarcopenia and osteopenia were measured with the Psoas Lumbar Vertebral Index (PLVI) and the M-Score, respectively. Patients were stratified by low vs. high PLVI and M-Score and then by postoperative complications. Multivariate analysis for independent risk factors was performed. A total of 392 patients (mean age 62.6 years, mean follow up 42.4 months) were included. Multivariate linear regression identified comorbidity Index (p = 0.006), and dural tear (p = 0.016) as independent risk factors for SSI, and age (p = 0.014) and diabetes (p = 0.43) for PJD. Low M-score and PLVI were not correlated to a higher complications rate. Age, comorbidity index, diabetes, dural tear and length of stay are independent risk factors for infection and/or proximal junctional disease in patients who undergo lumbar arthrodesis for degenerative disc disease, while central sarcopenia and osteopenia (as measured by PLVI and M-score) are not.

A Pilot Study on Circulating, Cellular, and Tissue Biomarkers in Osteosarcopenic Patients

“…Demographic and clinical data, such as age, gender, BMI, length of stay, therapy/drugs used, magnetic resonance image (MRI) findings, and blood tests before surgery (white blood cells, red blood cells, hemoglobin, hematocrit, MCV, MCH, MCHC, RDW (%), RDW DV, neutrophils, lymphocytes, monocytes, eosinophils, basophils, platelets count, MPV, prothrombic activity ratio, prothrombic activity INR, aPPT, and C-reactive protein), as well as comorbidities assessed using the Elixhauser Comorbidity Index (ECI) and polypharmacy, were collected. Central sarcopenia and osteopenia were evaluated for every patient through MRI, measuring PLVI [ 53 ] and the M-score [ 54 ], respectively: PLVI was determined by dividing the average cross-sectional area (CSA) of the psoas muscle by the average area of the L4 vertebrae, PLVI = (left psoas CSA + right psoas CSA)/(2 × L4 vertebral body CSA), as described previously [ 55 , 56 ]. The M-score was calculated based on the T1W spin-echo sequence of the preoperative MRI.…”

“…PLVI was determined by dividing the average cross-sectional area (CSA) of the psoas muscle by the average area of the L4 vertebrae, PLVI = (left psoas CSA + right psoas CSA)/(2 × L4 vertebral body CSA), as described previously [ 55 , 56 ].…”

What Types of Strategies Are Effective in Lumbar Spine Surgery? Considering the Etiology, Imaging Findings, and Risk of Complications

“…These risk factors are not fully understood. Therefore, imaging analysis using CT has shown that osteopenia and sarcopenia are associated with SSI [ 5 ]. Sarcopenia and osteopenia are independent risk factors for SSI and PJD after surgery.…”

“…In conclusion, as a strategy for lumbar spine surgery, the etiology and pathophysiology of the disease are first inferred [ 1 , 16 ], and the extent of the surgery is then determined based on spinal canal stenosis, the presence or absence of bony unions such as DISH [ 7 ], and the morphology of the fracture [ 17 ] based on image analysis [ 4 , 5 , 7 ]. Next, after selecting minimally invasive surgery [ 10 ], microendoscopic surgery [ 9 , 10 ], or conventional surgery as the surgical method, appropriate spinal instruments and cages [ 18 ] are selected.…”