Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Eur Spine J. 2022 Jun;31(6):1431-1437. doi: 10.1007/s00586-022-07151-9. Epub 2022 Mar 11.
Correction surgeries for spinal malalignment showed good clinical outcomes; however, there were concerns including increased invasiveness, complications, and impact on medico-economics. Ideally, an early intervention is needed. To better understand the patho-mechanism and natural course of spinal alignment, the effect of factors such as muscle mass and strength on spinal sagittal imbalance were determined in a multicenter cross-sectional study.
After excluding metal implant recipients, 1823 of 2551 patients (mean age: 69.2 ± 13.8 years; men 768, women 1055) were enrolled. Age, sex, past medical history (Charlson comorbidity index), body mass index (BMI), grip strength (GS), and trunk muscle mass (TM) were reviewed. Spinal sagittal imbalance was determined by the SRS-Schwab classification. Multiple comparison analysis among four groups (Normal, Mild, Moderate, Severe) and multinomial logistic regression analysis were performed.
On multiple comparison analysis, with progressing spinal malalignment, age in both sexes tended to be higher; further, TM in women and GS in both sexes tended to be low. On multinomial logistic regression analysis, age and BMI were positively associated with spinal sagittal malalignment in Mild, Moderate, and Severe groups. TM in Moderate and Severe groups and GS in the Moderate group were negatively associated with spinal sagittal malalignment.
Aging, obesity, low TM, and low GS are potential risk factors for spinal sagittal malalignment. Especially, low TM and low GS are potentially associated with more progressed spinal sagittal malalignment. Thus, early intervention for muscles, such as exercise therapy, is needed, while the spinal sagittal alignment is normal or mildly affected.
脊柱失稳的矫正手术显示出良好的临床效果；然而，人们担心手术会增加侵袭性、并发症，并对医疗经济产生影响。理想情况下，需要早期干预。为了更好地了解脊柱对线的病理机制和自然病程，本多中心横断面研究旨在确定肌肉质量和力量等因素对脊柱矢状面失衡的影响。
排除金属植入物受者后，共纳入 2551 名患者中的 1823 名（平均年龄：69.2±13.8 岁；男性 768 名，女性 1055 名）。回顾了年龄、性别、既往病史（Charlson 合并症指数）、体重指数（BMI）、握力（GS）和躯干肌肉质量（TM）。脊柱矢状面失衡由 SRS-Schwab 分类确定。对四组（正常、轻度、中度、重度）进行多项比较分析，并进行多项逻辑回归分析。
在多项比较分析中，随着脊柱失稳程度的加重，两性的年龄均有升高趋势；进一步，女性的 TM 和两性的 GS 均有降低趋势。在多分类逻辑回归分析中，年龄和 BMI 与轻度、中度和重度组的脊柱矢状面失稳呈正相关。中重度组的 TM 和中重度组的 GS 与脊柱矢状面失稳呈负相关。
衰老、肥胖、TM 减少和 GS 降低是脊柱矢状面失稳的潜在危险因素。特别是 TM 和 GS 降低与更严重的脊柱矢状面失稳相关。因此，需要早期对肌肉进行干预，如运动疗法，当脊柱矢状面排列正常或轻度受影响时。
