Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Ziquan ¹ , ZHANG Cong ² , WANG Hai ¹ , YU Keyi ¹ , ZHANG Jianguo ¹ ,  WANG Yipeng ¹

1. Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China;
2. Department of Endocrinology, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding author：

WANG Yipeng, Email: ypwang@vip.126.com

Keywords：

Sarcopenia; posterior lumbar surgery; lumbar spinal stenosis; effectiveness

DOI：

10.7507/1002-1892.202202048

Video：

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Objective To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. Methods The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L₃ level, SMI<45.4 cm²/m² (men) and SMI<34.4 cm²/m² (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups (P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group (t=−3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. Results There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume (P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group (t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups (χ²=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up (P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group (P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups (t=−1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups (χ²=1.201, P=0.753). Conclusion Patients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.

Citation： LI Ziquan, ZHANG Cong, WANG Hai, YU Keyi, ZHANG Jianguo, WANG Yipeng. Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 745-750. doi: 10.7507/1002-1892.202202048 Copy

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2.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
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7.	Lee HS, Park KW, Kang J, et al. Sarcopenia index as a predictor of clinical outcomes in older patients with coronary artery disease. J Clin Med, 2020, 9(10): 3121. doi: 10.3390/jcm9103121.
8.	Moorthi RN, Avin KG. Clinical relevance of sarcopenia in chronic kidney disease. Curr Opin Nephrol Hypertens, 2017, 26(3): 219-228.
9.	Deng HY, Chen ZJ, Qiu XM, et al. Sarcopenia and prognosis of advanced cancer patients receiving immune checkpoint inhibitors: A comprehensive systematic review and meta-analysis. Nutrition, 2021, 90: 111345. doi: 10.1016/j.nut.2021.111345.
10.	Pessia B, Giuliani A, Romano L, et al. The role of sarcopenia in the pancreatic adenocarcinoma. Eur Rev Med Pharmacol Sci, 2021, 25(10): 3670-3678.
11.	Wiedmer P, Jung T, Castro JP, et al. Sarcopenia-molecular mechanisms and open questions. Ageing Res Rev, 2021, 65: 101200. doi: 10.1016/j.arr.2020.101200.
12.	尹鹏, 海涌, 杨晋才, 等. 经皮内镜下经椎间孔与传统后入路椎间融合术治疗伴有腰椎不稳的腰椎管狭窄症的疗效对比. 中国脊柱脊髓杂志, 2021, 31(3): 213-221.
13.	王华, 王超, 孙超, 等. 肌少症对经皮椎体后凸成形术治疗老年骨质疏松性胸腰段脊柱骨折手术疗效的影响. 中国医学科学院学报, 2021, 43(2): 153-158.
14.	Chua M, Hochberg U, Regev G, et al. Gender differences in multifidus fatty infiltration and sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis. Spine J, 2022, 22(1): 58-63.
15.	Yao L, Petrosyan A, Fuangfa P, et al. Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics. Skeletal Radiol, 2021, 50(3): 543-550.
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17.	Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc, 2014, 15(2): 95-101.
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19.	Giraudo C, Cavaliere A, Lupi A, et al. Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia. Quant Imaging Med Surg, 2020, 10(8): 1602-1613.
20.	Ligthart-Melis GC, Luiking YC, Kakourou A, et al. Frailty, sarcopenia, and malnutrition frequently (Co-) occur in hospitalized older adults: A systematic review and meta-analysis. J Am Med Dir Assoc, 2020, 21(9): 1216-1228.
21.	Brzeszczynski F, Brzeszczynska J, Duckworth AD, et al. The effect of sarcopenia on outcomes following orthopaedic surgery: a systematic review. Bone Joint J, 2022, 104-B(3): 321-330.
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23.	王牧川, 李子全, 刘书中, 等. 肌少症对脊柱疾病的影响. 中华骨与关节外科杂志, 2021, 14(12): 1033-1038.
24.	Yoshimura Y, Wakabayashi H, Nagano F, et al. Chair-stand exercise improves sarcopenia in rehabilitation patients after stroke. Nutrients, 2022, 14(3): 461. doi: 10.3390/nu14030461.
25.	Billot M, Calvani R, Urtamo A, et al. Preserving mobility in older adults with physical frailty and sarcopenia: Opportunities, challenges, and recommendations for physical activity interventions. Clin Interv Aging, 2020, 15: 1675-1690.
26.	Honaga K, Mori N, Akimoto T, et al. Investigation of the effect of nutritional supplementation with whey protein and vitamin d on muscle mass and muscle quality in subacute post-stroke rehabilitation patients: A randomized, single-blinded, placebo-controlled trial. Nutrients, 2022, 14(3): 685. doi: 10.3390/nu14030685.
27.	Uchitomi R, Oyabu M, Kamei Y. Vitamin D and sarcopenia: Potential of Vitamin D supplementation in sarcopenia prevention and treatment. Nutrients, 2020, 12(10): 3189. doi: 10.3390/nu12103189.
28.	Kupisz-Urbańska M, Płudowski P, Marcinowska-Suchowierska E. Vitamin D deficiency in older patients-problems of sarcopenia, drug interactions, management in deficiency. Nutrients, 2021, 13(4): 1247. doi: 10.3390/nu13041247.
29.	Toyoda H, Hoshino M, Ohyama S, et al. Impact of sarcopenia on clinical outcomes of minimally invasive lumbar decompression surgery. Sci Rep, 2019, 9(1): 16619. doi: 10.1038/s41598-019-53053-0.

1. Derstine BA, Holcombe SA, Goulson RL, et al. Quantifying sarcopenia reference values using lumbar and thoracic muscle areas in a healthy population. J Nutr Health Aging, 2017, 21(10): 180-185.
2. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
3. Ganapathy A, Nieves JW. Nutrition and sarcopenia-what do we know? Nutrients, 2020, 12(6): 1755. doi: 10.3390/nu12061755.
4. Lang T, Streeper T, Cawthon P, et al. Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int, 2010, 21(4): 543-559.
5. Chen Z, Li WY, Ho M, et al. The prevalence of sarcopenia in chinese older adults: Meta-analysis and meta-regression. Nutrients, 2021, 13(5): 1441. doi: 10.3390/nu13051441.
6. Sepúlveda-Loyola W, Osadnik C, Phu S, et al. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2020, 11(5): 1164-1176.
7. Lee HS, Park KW, Kang J, et al. Sarcopenia index as a predictor of clinical outcomes in older patients with coronary artery disease. J Clin Med, 2020, 9(10): 3121. doi: 10.3390/jcm9103121.
8. Moorthi RN, Avin KG. Clinical relevance of sarcopenia in chronic kidney disease. Curr Opin Nephrol Hypertens, 2017, 26(3): 219-228.
9. Deng HY, Chen ZJ, Qiu XM, et al. Sarcopenia and prognosis of advanced cancer patients receiving immune checkpoint inhibitors: A comprehensive systematic review and meta-analysis. Nutrition, 2021, 90: 111345. doi: 10.1016/j.nut.2021.111345.
10. Pessia B, Giuliani A, Romano L, et al. The role of sarcopenia in the pancreatic adenocarcinoma. Eur Rev Med Pharmacol Sci, 2021, 25(10): 3670-3678.
11. Wiedmer P, Jung T, Castro JP, et al. Sarcopenia-molecular mechanisms and open questions. Ageing Res Rev, 2021, 65: 101200. doi: 10.1016/j.arr.2020.101200.
12. 尹鹏, 海涌, 杨晋才, 等. 经皮内镜下经椎间孔与传统后入路椎间融合术治疗伴有腰椎不稳的腰椎管狭窄症的疗效对比. 中国脊柱脊髓杂志, 2021, 31(3): 213-221.
13. 王华, 王超, 孙超, 等. 肌少症对经皮椎体后凸成形术治疗老年骨质疏松性胸腰段脊柱骨折手术疗效的影响. 中国医学科学院学报, 2021, 43(2): 153-158.
14. Chua M, Hochberg U, Regev G, et al. Gender differences in multifidus fatty infiltration and sarcopenia and association with preoperative pain and functional disability in patients with lumbar spinal stenosis. Spine J, 2022, 22(1): 58-63.
15. Yao L, Petrosyan A, Fuangfa P, et al. Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics. Skeletal Radiol, 2021, 50(3): 543-550.
16. 中华医学会骨质疏松和骨矿盐疾病分会. 肌少症共识. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3): 215-227.
17. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc, 2014, 15(2): 95-101.
18. Albano D, Messina C, Vitale J, et al. Imaging of sarcopenia: old evidence and new insights. Eur Radiol, 2020, 30(4): 2199-2208.
19. Giraudo C, Cavaliere A, Lupi A, et al. Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia. Quant Imaging Med Surg, 2020, 10(8): 1602-1613.
20. Ligthart-Melis GC, Luiking YC, Kakourou A, et al. Frailty, sarcopenia, and malnutrition frequently (Co-) occur in hospitalized older adults: A systematic review and meta-analysis. J Am Med Dir Assoc, 2020, 21(9): 1216-1228.
21. Brzeszczynski F, Brzeszczynska J, Duckworth AD, et al. The effect of sarcopenia on outcomes following orthopaedic surgery: a systematic review. Bone Joint J, 2022, 104-B(3): 321-330.
22. Eguchi Y, Suzuki M, Yamanaka H, et al. Influence of skeletal muscle mass and spinal alignment on surgical outcomes for lumbar spinal stenosis. Asian Spine J, 2018, 12(3): 556-562.
23. 王牧川, 李子全, 刘书中, 等. 肌少症对脊柱疾病的影响. 中华骨与关节外科杂志, 2021, 14(12): 1033-1038.
24. Yoshimura Y, Wakabayashi H, Nagano F, et al. Chair-stand exercise improves sarcopenia in rehabilitation patients after stroke. Nutrients, 2022, 14(3): 461. doi: 10.3390/nu14030461.
25. Billot M, Calvani R, Urtamo A, et al. Preserving mobility in older adults with physical frailty and sarcopenia: Opportunities, challenges, and recommendations for physical activity interventions. Clin Interv Aging, 2020, 15: 1675-1690.
26. Honaga K, Mori N, Akimoto T, et al. Investigation of the effect of nutritional supplementation with whey protein and vitamin d on muscle mass and muscle quality in subacute post-stroke rehabilitation patients: A randomized, single-blinded, placebo-controlled trial. Nutrients, 2022, 14(3): 685. doi: 10.3390/nu14030685.
27. Uchitomi R, Oyabu M, Kamei Y. Vitamin D and sarcopenia: Potential of Vitamin D supplementation in sarcopenia prevention and treatment. Nutrients, 2020, 12(10): 3189. doi: 10.3390/nu12103189.
28. Kupisz-Urbańska M, Płudowski P, Marcinowska-Suchowierska E. Vitamin D deficiency in older patients-problems of sarcopenia, drug interactions, management in deficiency. Nutrients, 2021, 13(4): 1247. doi: 10.3390/nu13041247.
29. Toyoda H, Hoshino M, Ohyama S, et al. Impact of sarcopenia on clinical outcomes of minimally invasive lumbar decompression surgery. Sci Rep, 2019, 9(1): 16619. doi: 10.1038/s41598-019-53053-0.

Chinese Journal of Reparative and Reconstructive Surgery

Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis

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