Multifidus Sarcopenia Is Associated With Worse Patient-reported Outcomes Following Posterior Cervical Decompression and Fusion.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 10 2022
15 10 2022
Historique:
received:
14
12
2021
accepted:
21
04
2022
pubmed:
8
7
2022
medline:
4
10
2022
entrez:
7
7
2022
Statut:
ppublish
Résumé
Retrospective cohort study. 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). 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. 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. 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). 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. 3.
Sections du résumé
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.
Identifiants
pubmed: 35797647
doi: 10.1097/BRS.0000000000004386
pii: 00007632-202210150-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1426-1434Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Cruz-Jentoft AJ, Landi F, Schneider SM, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014;43:748–759.
Iqbal J, Denvir M, Gunn J. Frailty assessment in elderly people. Lancet 2013;381:1985–1986.
Deren ME, Babu J, Cohen EM, Machan J, Born CT, Hayda R. Increased mortality in elderly patients with sarcopenia and acetabular fractures. J Bone Joint Surg Am 2017;99:200–206.
Ebbeling L, Grabo DJ, Shashaty M, et al. Psoas:lumbar vertebra index: central sarcopenia independently predicts morbidity in elderly trauma patients. Eur J Trauma Emerg Surg 2014;40:57–65.
Jones K, Gordon-Weeks A, Coleman C, Silva M. Radiologically determined sarcopenia predicts morbidity and mortality following abdominal surgery: a systematic review and meta-analysis. World J Surg 2017;41:2266–2279.
Moisey LL, Mourtzakis M, Cotton BA, et al. Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care 2013;17:R206.
Sheetz KH, Waits SA, Terjimanian MN, et al. Cost of major surgery in the sarcopenic patient. J Am Coll Surg 2013;217:813–818.
Tarantino U, Piccirilli E, Fantini M, Baldi J, Gasbarra E, Bei R. Sarcopenia and fragility fractures: molecular and clinical evidence of the bone-muscle interaction. J Bone Joint Surg Am 2015;97:429–437.
Yeung SSY, Reijnierse EM, Pham VK, et al. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2019;10:485–500.
Zakaria HM, Schultz L, Mossa-Basha F, Griffith B, Chang V. Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery. Neurosurg Focus 2015;39:E5.
Bokshan SL, Han AL, DePasse JM, et al. Effect of sarcopenia on postoperative morbidity and mortality after thoracolumbar spine surgery. Orthopedics 2016;39:e1159–e1164.
Bourassa-Moreau E, Versteeg A, Moskven E, et al. Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine. Spine J 2020;20:22–31.
Charest-Morin R, Street J, Zhang H, et al. Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J 2018;18:245–254.
McKenzie JC, Wagner SC, Sebastian A, et al. Sarcopenia does not affect clinical outcomes following lumbar fusion. J Clin Neurosci 2019;64:150–154.
Moskven E, Bourassa-Moreau E, Charest-Morin R, Flexman A, Street J. The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature. Spine J 2018;18:2354–2369.
Ohyama S, Hoshino M, Terai H, et al. Sarcopenia is related to spinal sagittal imbalance in patients with spinopelvic mismatch. Eur Spine J 2019;28:1929–1936.
Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000;9:266–272.
Koshimizu H, Sakai Y, Harada A, Ito S, Ito K, Hida T. The impact of sarcopenia on cervical spine sagittal alignment after cervical laminoplasty. Clin Spine Surg 2018;31:E342–e346.
Cloney M, Smith AC, Coffey T, et al. Fatty infiltration of the cervical multifidus musculature and their clinical correlates in spondylotic myelopathy. J Clin Neurosci 2018;57:208–213.
Fortin M, Lazáry À, Varga PP, McCall I, Battié MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J 2016;25:1452–1459.
Hyun SJ, Bae CW, Lee SH, Rhim SC. Fatty degeneration of the paraspinal muscle in patients with degenerative lumbar kyphosis: a new evaluation method of quantitative digital analysis using MRI and CT scan. Clin Spine Surg 2016;29:441–447.
Pinter ZW, Wagner SC, Fredericks DR Jr, et al. Higher paraspinal muscle density effect on outcomes after anterior cervical discectomy and fusion. Global Spine J 2021;11:931–935.
Teichtahl AJ, Urquhart DM, Wang Y, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J 2015;15:1593–1601.
Urrutia J, Besa P, Lobos D, et al. Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients. Skeletal Radiol 2018;47:955–961.
Pinter ZW, Wagner S, Fredericks D Jr, et al. Cervical Paraspinal muscle fatty degeneration is not associated with muscle cross-sectional area: qualitative assessment is preferable for cervical sarcopenia. Clin Orthop Relat Res 2021;479:726–732.
Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D. Item Banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment 2011;18:263–283.
Owen RJ, Zebala LP, Peters C, McAnany S. PROMIS physical function correlation with NDI and mJOA in the surgical cervical myelopathy patient population. Spine (Phila Pa 1976) 2018;43:550–555.
Battaglia PJ, Maeda Y, Welk A, Hough B, Kettner N. Reliability of the Goutallier Classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manipulative Physiol Ther 2014;37:190–197.
Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 2010;10:469–474.
Steinhaus ME, Iyer S, Lovecchio F, et al. Minimal clinically important difference and substantial clinical benefit using PROMIS CAT in cervical spine surgery. Clin Spine Surg 2019;32:392–397.
Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 2010;19:1136–1144.
Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 2007;5:2.
Masaki M, Ikezoe T, Fukumoto Y, et al. Association of sagittal spinal alignment with thickness and echo intensity of lumbar back muscles in middle-aged and elderly women. Arch Gerontol Geriatr 2015;61:197–201.
Park S, Kim HJ, Ko BG, et al. The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis. Bone Joint J 2016;98-b:1093–1098.
Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976) 1993;18:830–836.
Shahidi B, Parra CL, Berry DB, et al. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976) 2017;42:616–623.
Toyoda H, Hoshino M, Ohyama S, et al. The association of back muscle strength and sarcopenia-related parameters in the patients with spinal disorders. Eur Spine J 2019;28:241–249.
Pinter ZW, Salmons HIt, Townsley SE, et al. Improved sagittal alignment is associated with early postoperative neck disability and pain related patient reported outcomes following posterior cervical decompression and fusion for myelopathy. World Neurosurg 2022;161:e654–e663.
Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 2015;76(suppl 1):S14–S21; discussion S21.
Kennamer BT, Arginteanu MS, Moore FM, Steinberger AA, Yao KC, Gologorsky Y. Complications of poor cervical alignment in patients undergoing posterior cervicothoracic laminectomy and fusion. World Neurosurg 2019;122:e408–e414.
Roguski M, Benzel EC, Curran JN, et al. Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2014;39:2070–2077.