Multifidus Sarcopenia Is Associated With Worse Patient-reported Outcomes Following Posterior Cervical Decompression and Fusion

Abstract

Study Design. Retrospective cohort study. Objective. The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following posterior cervical decompression and fusion (PCDF). Summary of Background Data. While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following PCDF has not been investigated. Materials and Methods. We performed a retrospective review of patients undergoing PCDF from C2 to T2 at a single institution between the years 2017 and 2020. Two independent reviewers who were blinded to the clinical outcome scores utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral multifidus muscles at the C5–C6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups. Results. We identified 99 patients for inclusion in this study, including 28 patients with mild sarcopenia, 45 patients with moderate sarcopenia, and 26 patients with severe sarcopenia. There was no difference in any preoperative PROM between the subgroups. Mean postoperative Neck Disability Index scores were lower in the mild and moderate sarcopenia subgroups (12.8 and 13.4, respectively) than in the severe sarcopenia subgroup (21.0, P<0.001). A higher percentage of patients with severe multifidus sarcopenia reported postoperative worsening of their 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=0.02). Conclusion. Patients with more severe paraspinal sarcopenia demonstrate less improvement in neck disability and physical function postoperatively and are substantially more likely to report worsening PROMs postoperatively. Level of Evidence. 3.

Is Severe Neck Pain a Contraindication to Performing Laminoplasty in Patients With Cervical Spondylotic Myelopathy?

“…Patients were classified as Goutalier 0 if there were no visible fat streaks in the muscle, Goutalier 1 if there were minimal fatty streaks in the muscle, Goutalier 2 if there was more muscle present than fat, Goutalier 3 if fat and muscle were present in equal quantity, and Goutalier 4 if more fat was present than muscle. Patients were then further classified as having either mild (Goutalier 0–1), moderate (Goutalier 1.5–2), or severe sarcopenia (Goutalier 2.5–4.0) based upon the Fuchs Modification of the Goutalier grading system 31…”

“…Patients were then further classified as having either mild (Goutalier 0-1), moderate (Goutalier 1.5-2), or severe sarcopenia (Goutalier 2.5-4.0) based upon the Fuchs Modification of the Goutalier grading system. 31 The occurrence of postoperative complications was determined based on the review of the electronic medical record. Superficial infection was classified as an infection that responded to antibiotics, whereas deep infection was defined as an infection requiring a return to the operating room for irrigation and debridement.…”

Paraspinal Sarcopenia is Associated With Worse Patient-Reported Outcomes Following Laminoplasty for Degenerative Cervical Myelopathy

“…In recent years, a novel approach to qualitatively assess paraspinal sarcopenia opportunistically on preoperative magnetic resonance imaging (MRI) has emerged, which has improved both the ease and reliability of sarcopenia assessments 19–23. Using this methodology, recent studies have demonstrated that paraspinal sarcopenia is associated with proximal junctional failures following thoracolumbar fusions and poor patient-reported outcomes (PROMs) and worsening cervical sagittal alignment following posterior cervical decompression and fusion 20,24,25. Despite increasing awareness of the detrimental effects of sarcopenia following spine fusion surgery, the impact of paraspinal sarcopenia on outcomes following cervical laminoplasty remains unknown.…”

Lower Hounsfield Units and Severe Multifidus Sarcopenia Are Independent Predictors of Increased Risk for Proximal Junctional Kyphosis and Failure Following Thoracolumbar Fusion

“…[14][15][16] Studies investigating cohorts of patients undergoing posterior cervicothoracic fusions for myelopathy have revealed that severe qualitative sarcopenia is associated with worse patient-reported outcomes, cervical sagittal balance, and junctional alignment. [17][18][19] However, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown. The present study is the first to assess the impact of paraspinal sarcopenia on the development of PJK and PJF following thoracolumbar spine fusion surgery using opportunistic evaluation of paraspinal fatty degeneration on preoperative magnetic resonance imaging (MRI).…”

“…Sarcopenia is the progressive loss of skeletal muscle mass and is a manifestation of frailty that is not accounted for by other risk stratification methods 14–16. Studies investigating cohorts of patients undergoing posterior cervicothoracic fusions for myelopathy have revealed that severe qualitative sarcopenia is associated with worse patient-reported outcomes, cervical sagittal balance, and junctional alignment 17–19. However, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown.…”