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

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 cervical laminoplasty. Background. While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following laminoplasty has not been investigated. Methods. We performed a retrospective review of patients undergoing laminoplasty from C4-6 at a single institution between 2010 and 2021. Two independent reviewers utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral transversospinales muscle group at the C5-6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups. Results. We identified 114 patients for inclusion in this study, including 35 patients with mild sarcopenia, 49 patients with moderate sarcopenia, and 30 patients with severe sarcopenia. There were no differences in preoperative PROMs between subgroups. Mean postoperative neck disability index scores were lower in the mild and moderate sarcopenia subgroups (6.2 and 9.1, respectively) than in the severe sarcopenia subgroup (12.9, P = 0.01). Patients with mild sarcopenia were nearly twice as likely to achieve minimal clinically important difference (88.6 vs. 53.5%; P < 0.001) and six times as likely to achieve SCB (82.9 vs. 13.3%; P = 0.006) compared with patients with severe sarcopenia. A higher percentage of patients with severe sarcopenia reported postoperative worsening of their neck disability index (13 patients, 43.3%; P = 0.002) and Visual Analog Scale Arm scores (10 patients, 33.3%; P = 0.03). Conclusion. Patients with severe paraspinal sarcopenia demonstrate less improvement in neck disability and pain postoperatively and are more likely to report worsening PROMs following laminoplasty.

Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty

“…Several studies have reported the relationship between clinical symptoms and CSB based on cSVA. [6][7][8][9][10][11][21][22][23][24][25] Our study revealed that varying degrees of postoperative △cSVA were associated with different levels of neurological recovery and neck pain. Patients in the deterioration group exhibited a worse JOA recovery rate compared with those in the stable and improvement groups (Table 3).…”

“…[6][7][8][9] Kim et al 10 and Zhang et al 11 reported that preoperative higher cSVA was a risk factor for loss of cervical lordosis (LCL) and poor outcomes after cervical LMP. Pinter et al 9 demonstrated that a significant increase in postoperative cSVA was associated with preoperative paraspinal sarcopenia and less improvement in neck pain and disability after cervical LMP. Recent studies have reported several factors related to the variations in cSVA after LMP.…”

“…Recent studies have reported several factors related to the variations in cSVA after LMP. 9,12,13 However, the impact of preoperative dynamic cervical sagittal alignment on the postoperative changes in cSVA after LMP remains elusive.…”

Sarcopenia in Lumbar and Cervical Spine Surgery

“…23 Unfortunately, studies have shown that after cervical laminoplasty, paraspinal sarcopenia as measured through the Fuchs modification to the Goutallier classification scheme has been correlated with increasing postoperative sagittal vertical axis (SVA) and loss of cervical lordosis. 23,24 Furthermore, spinal malalignment appears to be linked to sarcopenia and increased NDI scores in cross-sectional studies and in patients undergoing cervical laminoplasty. 23,25 Lumbar Spine Surgery…”

“…23,24 Furthermore, spinal malalignment appears to be linked to sarcopenia and increased NDI scores in cross-sectional studies and in patients undergoing cervical laminoplasty. 23,25 Lumbar Spine Surgery…”