Evans Alexander R, Smith Lonnie, Bakhsheshian Joshua, Anderson David B, Elliott James M, Shakir Hakeem J, Smith Zachary A
Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
Vanderbilt University, Nashville, TN, USA.
Geroscience. 2025 Apr;47(2):1471-1484. doi: 10.1007/s11357-024-01300-2. Epub 2024 Aug 14.
Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.
肌少症通常定义为骨骼肌质量和功能的丧失，可能对老年人产生不成比例的影响，并严重影响脊柱疾病。肌肉萎缩与众多临床问题相关，包括胸椎后凸、矢状垂直轴（SVA）增加、脊柱植入物失败和术后并发症。因此，本叙述性综述的目的是综合相关文献，详细阐述肌少症与肌少症对脊柱疾病治疗影响之间的交叉点。具体而言，我们关注病因、诊断与评估、对颈椎和腰椎的影响、脊柱强化手术、肿瘤性疾病、挥鞭样损伤以及恢复/预防等领域。通过检索PubMed和谷歌学术数据库，从建库至2024年7月12日，进行了一项叙述性综述，纳入所有队列研究、系统评价或随机对照试验。排除病例研究和会议摘要。肌少症的诊断依赖于对肌肉力量以及数量/质量的评估。力量可使用诸如步速、计时起立行走（TUG）测试或握力等临床工具进行评估，而肌肉数量/质量可通过计算机断层扫描（CT扫描）、磁共振成像（MRI）和双能X线吸收法（DXA扫描）进行评估。肌少症对接受颈椎和腰椎手术患者的临床病程通常具有负面影响，并且可能是肿瘤性脊柱疾病患者死亡率的预测指标。此外，严重的加速 - 减速（挥鞭样）损伤可能导致颈伸肌萎缩。干预和恢复措施包括营养或运动疗法，尽管缺乏营养干预的证据。肌少症是老年人群中广泛存在的一种病理状况，其诊断标准、对脊柱病理的影响以及恢复/预防措施仍未得到充分研究。然而，进一步了解这种具有治疗挑战性的病理状况至关重要，因为手术结果可能会受到肌少症状态的严重影响。
