Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study

Traversari, Matteo; Ruffilli, Alberto; Barile, Francesca; Cerasoli, Tosca; Manzetti, Marco; Viroli, Giovanni; Ialuna, Marco; Salamanna, Francesca; Mazzotti, Antonio; Fini, Milena; Faldini, Cesare

doi:10.4103/jcvjs.jcvjs_140_22

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…In recent years, literature on the impact of sarcopenia on postoperative outcomes after spine surgery has demonstrated a negative effect on patient-reported outcomes, as well as postoperative morbidity and mortality. 19,[35][36][37][38] In our study, the psoas index, often used to evaluate sarcopenia, 13 did not significantly correlate with ODI improvement after surgery. This finding has two important implications.…”

Section: Discussionmentioning

confidence: 60%

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Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis

Schönnagel,

Guven,

Camino-Willhuber

et al. 2023

Spine

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Study Design. Retrospective analysis of prospectively enrolled patients. Objective. To evaluate the relationship between paraspinal muscle (PM) atrophy and Oswestry Disability Index (ODI) improvement after spinal fusion surgery for degenerative lumbar spondylolisthesis (DLS). Background. Atrophy of the PM is linked to multiple spinal conditions, sagittal malalignment, and increased postoperative complications. However, only limited evidence for the effect on patient-reported outcomes exists. Methods. Patients with DLS undergoing decompression and fusion surgery were analyzed. Patients with missing follow-up, no imaging, or inadequate image quality were excluded. The Oswestry Disability Index (ODI) was assessed preoperatively and two years postoperatively. A cross-sectional area of the PM was measured on a T2-weighted Magnetic Resonance Imaging (MRI) sequence at the upper endplate of L4. Based on the literature, a 10-point improvement cut-off was defined as the minimum clinically important difference (MCID). Patients with a baseline ODI below the MCID were excluded. Logistic regression was used to calculate the association between fatty infiltration (FI) of the PM and improvement in ODI, adjusted for age, sex, and body mass index (BMI). Results. 133 patients were included in the final analysis, with only two lost to follow-up. The median age was 68 years (IQR 62 – 73). The median preoperative ODI was 23 (IQR 17 - 28), and 76.7% of patients showed improvement in their ODI score by at least 10 points. In the multivariable regression, FI of the erector spinae and multifidus increased the risk of not achieving clinically relevant ODI improvement (P=0.01 and P<0.001, respectively). No significant association was found for the psoas muscle (P=0.158). Conclusions. This study demonstrates that FI of the erector spinae and multifidus, is significantly associated with less likelihood of clinically relevant ODI improvement following decompression and fusion. Further research is needed to assess the effect of interventions.

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Section: Discussionmentioning

confidence: 60%

“…Atrophy of the posterior PM might also be a sign of underlying generalized sarcopenia. In recent years, literature on the impact of sarcopenia on postoperative outcomes after spine surgery has demonstrated a negative effect on patient-reported outcomes, as well as postoperative morbidity and mortality 19,35–38 …”

Section: Discussionmentioning

confidence: 99%

Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis

Schönnagel,

Guven,

Camino-Willhuber

et al. 2023

Spine

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“…41 Counter to this, psoas muscle size has been shown to be an independent predictor for developing PJD in short posterolateral lumbar fusion (ie, 3 levels or less) when assessed at the L4 vertebral body level controlling for vertebral body size. 42 Although these results largely conflict with that of Pennington et al, 41 it should be noted the later study focused solely on shorter fusions, fusions not requiring pelvic fixation, and measured psoas size at a single vertebral level, not solely at the UIV, as a ratio of the vertebral body CSA. However, like Pennington et al, 41 a study of individuals undergoing 1-to 2-level lumbar fusions demonstrated both decreased lean paraspinal muscle size at the L4/L5 level and decreased lean to total paraspinal mass as an independent predictor of ASD when controlling for demographics and fusion construct.…”

Section: Proximal Junctional Kyphosis and Failure In Lumbar Surgerymentioning

confidence: 80%

“…In 1 study of patients undergoing 2 or more level fusions extending caudally into the sacrum, paraspinal muscle markers (lean CSA, FI, and SMI) at the UIV were more predictive of ASD as opposed to signs of psoas degeneration 41. Counter to this, psoas muscle size has been shown to be an independent predictor for developing PJD in short posterolateral lumbar fusion (ie, 3 levels or less) when assessed at the L4 vertebral body level controlling for vertebral body size 42. Although these results largely conflict with that of Pennington et al,41 it should be noted the later study focused solely on shorter fusions, fusions not requiring pelvic fixation, and measured psoas size at a single vertebral level, not solely at the UIV, as a ratio of the vertebral body CSA.…”

Section: Spinal Alignment and Adjacent Segment Diseasementioning

confidence: 93%

Sarcopenia in Lumbar and Cervical Spine Surgery

Staub,

Oris,

Khazanchi

et al. 2024

Contemporary Spine Surgery

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Sarcopenia Predicts the Development of Early Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion

Wilkinson,

Maloney,

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Predicting the development of adjacent segment disease (ASD) after lumbar spine fusion would help guide preoperative and postoperative therapies to prevent reoperation. We sought to evaluate whether sarcopenia predicts the development of early ASD after transforaminal lumbar interbody fusion (TLIF). METHODS: Retrospective data were collected from 109 patients who underwent TLIF from 2013 to 2023. Patients older than 18 years who underwent elective posterior midline approach TLIF were included. Patients with prior lumbar instrumented fusions, cases of trauma, central nervous system infection, cancer, or long-construct thoracolumbar deformity corrections and those who lacked sufficient follow-up were excluded. The primary outcome was radiographic ASD development within 3 years of surgery. Psoas volumetric measurements were recorded from the most recent preoperative MRI. Odds ratios were calculated with logistic regression analyses. RESULTS: In 109 patients undergoing elective TLIF, 22 (20.2%) developed ASD within 3 years. Gender, body mass index, and extent of surgery were not associated with ASD development. Multivariate analysis showed left/right psoas cross-sectional area, and psoas:vertebral body ratio (P:VBR) predicted early ASD (P < .0001). Sarcopenia was further categorized as having bilateral P:VBR ≥1 SD below gender mean (T-score −1). Of 18 sarcopenic patients, 15 developed early ASD (83.33%) vs 7 of 91 nonsarcopenic patients (7.69%; P < .0001). Postoperative mismatch between pelvic incidence and lumbar lordosis was predictive of ASD on univariate (P = .0480) but not multivariate analysis. Pelvic tilt and lumbar lordosis postoperatively were not associated with early ASD. CONCLUSION: Sarcopenia, measured by decreased psoas area and P:VBR, predicts ASD formation within 3 years of surgery. Morphometric analysis of psoas size is a simple tool to identify patients at risk of developing ASD. This information can potentially guide preoperative and postoperative therapies, affect surgical decision making, and effectively counsel patients on risks of reoperation.

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Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study

Cited by 3 publications

References 27 publications

Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis

Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis

Sarcopenia in Lumbar and Cervical Spine Surgery

Sarcopenia Predicts the Development of Early Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion

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