Sarcopenia Is an Independent Risk Factor for Proximal Junctional Disease Following Adult Spinal Deformity Surgery

Abstract

Study Design: Retrospective cohort study. Objectives: Sarcopenia is a risk factor for medical complications following spine surgery. However, the role of sarcopenia as a risk factor for proximal junctional disease (PJD) remains undefined. This study evaluates whether sarcopenia is an independent predictor of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery. Methods: ASD patients who underwent thoracic spine to pelvis fusion with 2-year clinical and radiographic follow-up were reviewed for development of PJK and PJD. Average psoas cross-sectional area on preoperative axial computed tomography or magnetic resonance imaging at L4 was recorded. Previously described PJD risk factors were assessed for each patient, and multivariate linear regression was performed to identify independent risk factors for PJK and PJF. Disease-specific thresholds were calculated for sarcopenia based on psoas cross-sectional area. Results: Of 32 patients, PJK and PJF occurred in 20 (62.5%) and 12 (37.5%), respectively. Multivariate analysis demonstrated psoas cross-sectional area to be the most powerful independent predictor of PJK ( P = .02) and PJF ( P = .009). Setting ASD disease–specific psoas cross-sectional area thresholds of <12 cm2 in men and <8 cm2 in women resulted in a PJF rate of 69.2% for patients below these thresholds, relative to 15.8% for those above the thresholds. Conclusions: Sarcopenia is an independent, modifiable predictor of PJK and PJF, and is easily assessed on standard preoperative computed tomography or magnetic resonance imaging. Surgeons should include sarcopenia in preoperative risk assessment and consider added measures to avoid PJF in sarcopenic patients.

Association Between Paravertebral Muscle Mass and Improvement in Sagittal Imbalance After Decompression Surgery of Lumbar Spinal Stenosis

“…To assess preoperative status of spinal sarcopenia, we used T2-weighted MRI with an axial view at the level of the L4 lower end plate. According to previous reports that the cross-sectional area (CSA) of the skeletal muscle was a good indicator of spinal sarcopenia, [28][29][30] the CSA of the bilateral paravertebral muscles (PVMs) and psoas muscles (PMs) as well as the vertebral body were measured by drawing outlines and calculated in square-millimeters using the PACS system (Synapse ver. 4.4.3) (Figure 1).…”

Influence of Preoperative Handgrip Strength on Length of Stay after Lumbar Fusion Surgery

“…History of previous lumbar surgery was more frequently observed in patients with preoperative low HGS. A higher incidence of revisional spinal surgery was reported in patients with sarcopenia because disease in adjacent segments occurred more frequently after surgery [ 22 , 23 ]. In addition, a higher ODI score, indicating poor functional status, was measured in the low HGS group.…”

Complications of adult spinal deformity surgery: A literature review

“…Minimally invasive surgical techniques are associated with less blood loss and less muscle damage. [ 31 32 33 ] Than et al . compared MIS to the hybrid group and revealed no significant difference in major complications and reoperations.…”

“…[ 13 62 64 65 66 ] Furthermore, it is related to the disruption of posterior soft-tissue and ligamentous structures. [ 33 67 ] The radiologic risk factors for PJK were identified as excessive SVA corrections and excessive lumbar lordosis. [ 68 69 ] Recurrent PJK is associated with increased anterior malalignment, increased thoracic pelvic angle, and SVA.…”