Joseph Karan, Ruiz-Cardozo Miguel A, Barot Karma A, Trevino Gabriel, Bui Tim T, Vogl Samuel J, Brehm Samuel N, Strok Matthew J, Yakdan Salim, Kann Michael R, Lopez-Alviar Sofia, Yahanda Alexander T, Cadieux Magalie, Molina Camilo A
Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Craniovertebr Junction Spine. 2025 Jan-Mar;16(1):81-88. doi: 10.4103/jcvjs.jcvjs_188_24. Epub 2025 Apr 1.
Sarcopenia, a manifestation of frailty characterized by muscle loss, is associated with adverse postoperative events in spinal patients. Its role in postlaminoplasty kyphotic deformities (PKDs) remains unknown.
This study evaluates the relationship between paraspinal muscle sarcopenia and PKD using qualitative and quantitative methods.
A retrospective review was conducted on cervical myelopathy patients treated with laminoplasty between January 2019 and January 2022 at a tertiary care center. Inclusion criteria included pre- and 1-year postoperative X-rays and magnetic resonance imaging within 6 months presurgery. PKD was defined as loss of cervical lordosis greater than -10° based on the C2-7 Cobb angle. Fatty infiltration was evaluated using Goutallier classification and voxel quantification.
Among 44 patients, 4 developed PKD. Qualitatively, 32 patients were classified as Goutallier 0-1.5, 6 were Goutallier 1.5-2.5, and 6 Goutallier 2.5-4. There is a significant association between the Goutallier grade and PKD occurrence after 1 year (P = 0.00085). Quantitatively, the average fatty infiltration percentage for the kyphotic patients was 23.3% ± 5.81% versus 13.8% ± 9.83% for nonkyphotic patients. A significant association was found between the percentage of fatty infiltration and the PKD after 1 year (P = 0.045). The optimal fat cutoff between kyphotic and nonkyphotic patients was 23% (P = 0.056).
The present study demonstrated that patients with higher degree of fatty infiltration were associated with PKD. Based on our results, patients with increased cervical paraspinal degeneration may have increased risk of developing PKD. With this information, surgeons may be better equipped to predict the risk of PKD.
肌肉减少症是虚弱的一种表现，其特征为肌肉流失，与脊柱手术患者术后不良事件相关。其在椎板成形术后后凸畸形（PKD）中的作用尚不清楚。
本研究采用定性和定量方法评估椎旁肌肌肉减少症与PKD之间的关系。
对2019年1月至2022年1月在一家三级医疗中心接受椎板成形术治疗的颈椎病患者进行回顾性研究。纳入标准包括术前和术后1年的X线片以及术前6个月内的磁共振成像。根据C2-7 Cobb角，PKD定义为颈椎前凸丢失大于-10°。使用Goutallier分类法和体素定量法评估脂肪浸润情况。
44例患者中，4例发生PKD。定性分析中，32例患者被分类为Goutallier 0-1.5级，6例为Goutallier 1.5-2.5级，6例为Goutallier 2.5-4级。Goutallier分级与1年后PKD的发生之间存在显著相关性（P = 0.00085）。定量分析中，后凸患者的平均脂肪浸润百分比为23.3%±5.81%，而非后凸患者为13.8%±9.83%。1年后发现脂肪浸润百分比与PKD之间存在显著相关性（P = 0.045）。后凸和非后凸患者之间的最佳脂肪临界值为23%（P = 0.056）。
本研究表明脂肪浸润程度较高的患者与PKD相关。根据我们的结果，颈椎椎旁退变增加的患者发生PKD的风险可能增加。有了这些信息，外科医生可能更有能力预测PKD的风险。
