Correlation analysis of sagittal alignment and skeletal muscle mass in patients with spinal degenerative disease

Abstract

We investigated how skeletal muscle mass (SMM) affects spinal sagittal balance (radiographic parameters) in symptomatic spinal patients. The first purpose of this study was to evaluate the body composition and the spinal sagittal alignment in symptomatic spinal patients. The second purpose of this study was to compare whether the body composition and the spinal sagittal alignment is different in patients with cervical spine disease and lumbar spine disease. We retrospectively evaluated 313 patients who were hospitalized for surgery to treat spinal degenerative disease, who were divided into cervical and lumbar spine disease groups. All patients underwent full-length standing whole-spine radiography and bioimpedance analysis (BIA) before surgery. We used standard measurements to assess the sagittal vertical axis (SVA), cervical lordosis (CL; C2–C7), lumbar lordosis (LL; T12–S1), thoracic kyphosis (TK; T5–12), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). We also analyzed radiological and body composition parameters, patient characteristics, and the correlation between SMM and each sagittal parameters. In the overall cohort, the mean age at the time of operation was 66.5 ± 15.3 years and 59.2% of the patients were men. The correlation coefficients (r) between SMM and PT were negative weak correlation (r = −0.343, P < 0.001). The correlation with SMM for other LL, PI, SS, and SVA was statistically significant, but the correlation was none. In addition, our results also suggested strong correlations (r > 0.5) between LL and SS (r = 0.744), between LL and SVA (r = −0.589), between PT and SS (r = −0.580), and LL and PT (r = −0.506). Fifty-seven patients (18.2%, cervical group) had cervical spine disease and 256 patients (81.8%, lumbar group) had lumbar spine disease. No significant differences in age, height, body weight, and body mass index were observed between the two groups. The SMM of patients with cervical and lumbar spine disease also did not differ significantly. In the lumbar group, correlations were found between SMM and PT (r = −0.288, P < 0.001), between SMM and LL (r = 0.179, P < 0.01), and between SMM and SS (r = 0.170, P < 0.01), while only PT (r = −0.480, P < 0.001) was negatively correlated with SMM in the cervical group. This analysis indicated that PT is the sagittal parameter most closely related to SMM in patients with the spinal degenerative disease. The SMM might be one of the important factors that influenced the posterior inclination of the pelvis in symptomatic spinal patients, especially in cervical spine disease.

The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis

“…Radiographic parameters of interest included sagittal balance (C7-SVA), cervical lordosis (CL; C2–C7), lumbar lordosis (LL; L1–S1), thoracic kyphosis (TK; T5–T12), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) [17, 18]. The C7-SVA was determined by the horizontal offset between a plumb line drawn from the center of C7 and the posterosuperior corner of the S1 endplate.…”

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

“…Furthermore, in the DLS group, the spinal sarcopenia subgroup exhibited inferior results in a timed up and go test and had poorer Oswestry disability index scores compared with the non-spinal sarcopenia subgroup. Regarding patients with degenerative spinal diseases, studies have indicated that the pelvic tilt angle is the sagittal parameter most closely related to skeletal muscle mass [45]. Skeletal muscle mass might be a crucial factor related to the posterior inclination of the pelvis in symptomatic patients with spinal conditions, especially cervical spine disease.…”

“…In recent years, several original articles have discussed how spinal sarcopenia influences spinal parameters in individuals, including cervical lordosis, thoracic kyphosis, and lumbar lordosis [43][44][45][46]. Notably, these spinal changes often lead to pathologic conditions such as degenerative scoliosis and compression fractures which are associated with poor life quality compared to their normal counterpart [46].…”

The Sagittal Balance of the Cervical Spine: Radiographic Analysis of Interdependence between the Occipitocervical and Spinopelvic Alignment

“…Therefore, more attention is often paid to sagittal balance than coronal balance during spinal deformity assessment, surgical plan-making, and surgical procedure. Generally, sagittal imbalance results in increased muscular effort and energy expenditure, causing pain, fatigue, and disability [5]. Sagittal imbalance of the spine as a crucial factor in the pathogenesis of myelopathy is supported by several reports [6,7].…”

“…Multiple studies have described normative values for parameters of spinopelvic alignment in different populations of varying ages and pathologic conditions. In these studies, the interrelation of pelvic parameters, LL, TK, sagittal imbalance, and its effect on the quality of life and patient outcome has been well-established [5,8,9]. Many studies have reported that pelvic incidence (PI), a constant morphological parameter in each individual, has a significant influence on sagittal alignment of the lumbar spine or the thoracic spine, such as LL and TK [10].…”