Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
Spine (Phila Pa 1976). 2022 Oct 15;47(20):1426-1434. doi: 10.1097/BRS.0000000000004386. Epub 2022 Jul 1.
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.
回顾性队列研究。
本研究首次评估了椎旁骨骼肌减少症对颈椎后路减压融合术（PCDF）后患者报告的结果测量（PROM）的影响。
虽然骨骼肌减少症对腰椎手术后 PROM 的影响已得到充分证实，但椎旁骨骼肌减少症对 PCDF 后 PROM 的影响尚未得到研究。
我们对 2017 年至 2020 年在一家机构接受 C2 至 T2 节段 PCDF 的患者进行了回顾性研究。两名独立的、对临床结果评分不知情的审查员使用 T2 加权磁共振成像序列的轴向切片来评估双侧多裂肌在 C5-C6 水平的脂肪浸润情况，并根据 Fuchs 改良 Goutalier 分级系统对患者进行分类。然后比较了 PROM 亚组之间的差异。
我们共纳入 99 例患者，其中 28 例患者为轻度骨骼肌减少症，45 例患者为中度骨骼肌减少症，26 例患者为重度骨骼肌减少症。亚组之间在任何术前 PROM 方面均无差异。轻度和中度骨骼肌减少症亚组的平均术后颈部残疾指数评分（分别为 12.8 和 13.4）低于重度骨骼肌减少症亚组（21.0，P<0.001）。更多的重度多裂肌骨骼肌减少症患者报告术后颈部残疾指数（10 例，38.5%；P=0.003）、视觉模拟量表颈部评分（7 例，26.9%；P=0.02）、患者报告的结果测量信息系统身体成分评分（10 例，38.5%；P=0.02）和患者报告的结果测量信息系统心理成分评分（14 例，53.8%；P=0.02）恶化。
椎旁骨骼肌减少症越严重的患者术后颈部残疾和身体功能改善越小，术后报告 PROM 恶化的可能性显著更高。
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