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Sarcopenia at the upper instrumented vertebra is more significantly associated with proximal junctional kyphosis after long fusion for adult spinal deformity surgery than osteopenia – Lumbar Fusion

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The article discusses proximal junctional kyphosis (PJK), a mechanical complication that occurs after adult spinal deformity (ASD) surgery. The study aimed to determine the significant risk factor for PJK between osteopenia and sarcopenia. The researchers retrospectively analyzed patients older than 50 years who underwent ASD surgery. Various parameters such as radiographic sagittal parameters and Hounsfield unit (HU) values were measured. PJK was observed in 11 out of 29 patients, and it was found that fatty infiltration ratio (FI%) in the paraspinal musculature was significantly higher in patients with PJK compared to those without. Logistic regression analysis identified FI% as a significant independent factor for PJK. The study concludes that sarcopenia, assessed through fatty degeneration of the paraspinal musculature, is a more important risk factor for PJK than osteopenia

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

Proximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied patients older than 50 years who underwent ASD surgery from the lower thoracic spine to the pelvis. In addition to patient demographic data and pre- and post-operative radiographic sagittal…

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J Clin Neurosci. 2023 Aug 17;116:13-19. doi: 10.1016/j.jocn.2023.08.012. Online ahead of print.ABSTRACTProximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied,

J Clin Neurosci. 2023 Aug 17;116:13-19. doi: 10.1016/j.jocn.2023.08.012. Online ahead of print.

ABSTRACT

Proximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied patients older than 50 years who underwent ASD surgery from the lower thoracic spine to the pelvis. In addition to patient demographic data and pre- and post-operative radiographic sagittal parameters (PI: pelvic incidence; LL: lumbar lordosis; SVA: sagittal vertical axis; PT: pelvic tilt), Hounsfield unit (HU) values on preoperative computed tomography and cross sectional area (CSA) and fatty infiltration ratio (FI%) of the paraspinal musculature (PSM) on preoperative magnetic resonance image were measured from the upper-instrumented vertebra (UIV) to UIV + 2 and averaged. PJK was observed in 11 of 29 patients. There was no statistical difference between the patients with and without PJK in age at surgery, sex, body mass index, bone mineral density, preoperative PI-LL, SVA, PT, postoperative PI-LL, SVA, PT, HU, and CSA. FI% in patients with PJK (25.0) was significantly higher than that (15.3) in patients without PJK (P = 0.001). Logistic regression analysis identified FI% of PSM as a significant independent factor of PJK (odds ratio, 1.973; 95% confidence interval, 1.290-5.554; P < 0.0001). After successful elimination of possible factors related to PJK other than sarcopenia and osteopenia, sarcopenia assessed by fatty degeneration of the PSM at the UIV was shown to be a more important factor than osteopenia for PJK after long fusion for ASD.

PMID:37597329 | DOI:10.1016/j.jocn.2023.08.012

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Sarcopenia at the upper instrumented vertebra is more significantly associated with proximal junctional kyphosis after long fusion for adult spinal deformity surgery than osteopenia

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J Clin Neurosci. 2023 Aug 17;116:13-19. doi: 10.1016/j.jocn.2023.08.012. Online ahead of print.ABSTRACTProximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied

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