Hirase Takashi, Lovecchio Francis C, Allen Myles R J, Achebe Chukwuebuka C, Mazzucco Michael, Uzzo Robert N, Kazarian Gregory S, Asada Tomoyuki, Nakarai Hiroyuki, Subramanian Tejas, Simon Chad Z, Durbas Atahan, Kaidi Austin C, Araghi Kasra, Samuel Justin T, Kwas Cole, Albert Todd J, Kim Han Jo
Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2025 Feb 1;50(3):172-178. doi: 10.1097/BRS.0000000000005056. Epub 2024 May 29.
Retrospective cohort study.
To determine the relationship between preoperative physical therapy (PT) and postoperative mobility, adverse events (AEs), and length of stay (LOS) among patients with low normalized total psoas area (NTPA) undergoing adult spinal deformity (ASD) surgery.
Sarcopenia, as defined by low NTPA, has been shown to predict poor perioperative outcomes of ASD surgery. However, there is limited evidence correlating the benefits of PT within the patient population with sarcopenic.
NTPA was analyzed at the L3 and L4 mid-vertebral bodies on preoperative magnetic resonance imaging. Receiver operating characteristic curve analysis was used to determine sex-specific NTPA cutoff values for predicting perioperative AEs. Patients were categorized as having low NTPA if both L3 and L4 NTPA were below these cutoff values. Perioperative outcomes were compared between patients with low NTPA who underwent documented formal PT within 6 months before ASD surgery with those who did not.
A total of 103 patients (42 males, 61 females) met the criteria for low NTPA for inclusion in the study, of which 42 underwent preoperative PT and 61 did not. The preoperative PT group had a shorter LOS (111.2 ± 37.5 vs . 162.1 ± 97.0 h, P < 0.001), higher ambulation distances (feet) on postoperative day (POD) 1 (61.7 ± 50.3 vs . 26.1 ± 69.0, P < 0.001), POD 2 (113.2 ± 81.8 vs . 62.1 ± 73.1, P = 0.003), and POD 3 (126.0 ± 61.2 vs . 91.2 ± 72.6, P = 0.029), and lower rates of total AEs (31.0% vs . 54.1%, P = 0.003) when excluding anemia requiring transfusion. Multivariable analysis found preoperative PT to be the most significant predictor of decreased LOS (odds ratio: 0.32, P = 0.013).
Patients with sarcopenia may benefit from formal preoperative PT before undergoing ASD surgery to improve early postoperative mobility, decrease adverse eveents, and reduce length of stay.
Level III.
回顾性队列研究。
确定术前物理治疗（PT）与成人脊柱畸形（ASD）手术中归一化总腰大肌面积（NTPA）较低的患者术后活动能力、不良事件（AE）及住院时间（LOS）之间的关系。
低NTPA定义的肌肉减少症已被证明可预测ASD手术围手术期预后不良。然而，关于肌肉减少症患者群体中PT益处的相关证据有限。
在术前磁共振成像上分析L3和L4椎体中部的NTPA。采用受试者工作特征曲线分析确定预测围手术期AE的性别特异性NTPA临界值。若L3和L4的NTPA均低于这些临界值，则患者被归类为NTPA较低。比较在ASD手术前6个月内接受过正规PT记录的低NTPA患者与未接受过的患者的围手术期结局。
共有103例患者（42例男性，61例女性）符合纳入研究的低NTPA标准，其中42例接受了术前PT，61例未接受。术前PT组的住院时间较短（111.2±37.5 vs. 162.1±97.0小时，P<0.001），术后第1天（POD 1）、POD 2和POD 3的行走距离（英尺）更高（POD 1：61.7±50.3 vs. 26.1±69.0，P<0.001；POD 2：113.2±81.8 vs. 62.1±73.1，P = 0.003；POD 3：126.0±61.2 vs. 91.2±72.6，P = 0.029），排除需要输血的贫血后，总AE发生率更低（31.0% vs. 54.1%，P = 0.003）。多变量分析发现术前PT是住院时间缩短的最显著预测因素（比值比：0.32，P = 0.013）。
肌肉减少症患者在接受ASD手术前可能从正规的术前PT中获益，以改善术后早期活动能力、减少不良事件并缩短住院时间。
三级。
