Eleswarapu Ananth, O'Connor Daniel, Rowan Flynn Andrew, Van Le Hai, Wick Joseph B, Javidan Yashar, Rolando Roberto, Klineberg Eric O
NYU Langone Medical Center, 5894New York, NY, USA.
8789University of California Davis Medical Center, Sacramento, CA, USA.
Global Spine J. 2022 Jan;12(1):102-109. doi: 10.1177/2192568220947050. Epub 2020 Aug 30.
Retrospective cohort study.
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.
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.
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 ( = .02) and PJF ( = .009). Setting ASD disease-specific psoas cross-sectional area thresholds of <12 cm in men and <8 cm in women resulted in a PJF rate of 69.2% for patients below these thresholds, relative to 15.8% for those above the thresholds.
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.
回顾性队列研究。
肌肉减少症是脊柱手术后发生医学并发症的一个危险因素。然而，肌肉减少症作为近端交界性疾病（PJD）危险因素的作用仍不明确。本研究评估肌肉减少症是否是成人脊柱畸形（ASD）手术后近端交界性后凸畸形（PJK）和近端交界性失败（PJF）的独立预测因素。
对接受胸段脊柱至骨盆融合术并进行了2年临床和影像学随访的ASD患者进行PJK和PJD发生情况的回顾。记录术前L4水平轴向计算机断层扫描或磁共振成像上的腰大肌平均横截面积。对每位患者评估先前描述的PJD危险因素，并进行多变量线性回归以确定PJK和PJF的独立危险因素。根据腰大肌横截面积计算肌肉减少症的疾病特异性阈值。
32例患者中，分别有20例（62.5%）发生PJK，12例（37.5%）发生PJF。多变量分析表明，腰大肌横截面积是PJK（P = 0.02）和PJF（P = 0.009）最有力的独立预测因素。设定男性ASD疾病特异性腰大肌横截面积阈值<12 cm，女性<8 cm，低于这些阈值的患者PJF发生率为69.2%，而高于阈值的患者为15.8%。
肌肉减少症是PJK和PJF的独立、可改变的预测因素，并且在标准术前计算机断层扫描或磁共振成像上易于评估。外科医生应在术前风险评估中纳入肌肉减少症，并考虑采取额外措施以避免肌肉减少症患者发生PJF。
