Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study

Alberto Ruffilli; Francesca Barile; Tosca Cerasoli; Marco Manzetti; Giovanni Viroli; Marco Ialuna; Matteo Traversari; Francesca Salamanna; Antonio Mazzotti; Milena Fini; Cesare Faldini

doi:10.4103/jcvjs.jcvjs_140_22

Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study

J Craniovertebr Junction Spine. 2023 Jan-Mar;14(1):65-70. doi: 10.4103/jcvjs.jcvjs_140_22. Epub 2023 Mar 13.

Affiliations

¹ Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
² Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
³ Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Abstract

Study design: This was a retrospective study.

Objective: Since a better understanding of modifiable risk factors for proximal junctional disease (PJD) may lead to improved postoperative outcomes and less need of revision surgery, the aim of the present study is to determine whether sarcopenia and osteopenia are independent risk factors for PJD in patients undergoing lumbar fusion.

Summary of background data: PJD is one of the most frequent complications following posterior instrumented spinal fusion. It is characterized by a spectrum of pathologies ranging from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). The etiology of PJD is multifactorial and currently not fully understood. Patient-specific factors, such as age, body mass index, osteoporosis, sarcopenia, and the presence of other comorbidities, can represent potential risk factors.

Materials and methods: A retrospective review of patients, aging 50-85 years, who underwent a short (≤3 levels) posterior lumbar fusion for degenerative diseases was performed. Through magnetic resonance imaging (MRI), central sarcopenia and osteopenia were evaluated, measuring the psoas-to-lumbar vertebral index (PLVI) and the M-score. A multivariate analysis was performed to determine the independent risk factors for PJD, PJK, and PJF.

Results: A total of 308 patients (mean age at surgery 63.8 ± 6.2 years) were included. Ten patients (3.2%) developed a PJD and all required revision surgery. Multivariate regression identified PLVI (P = 0.02) and M-score (P = 0.04) as independent risk factors for both PJK (P = 0.02 and P = 0.04, respectively) and PJF (P = 0.04 and P = 0.01, respectively).

Conclusions: Sarcopenia and osteopenia, as measured by PLVI and M-score, proved to be independent risk factors for PJD in patients who undergo lumbar fusion for degenerative diseases.

Clinical trial registration: The present study was approved by the Institutional Review Board, CE AVEC 208/2022/OSS/IOR.

Keywords: Degenerative disease; osteopenia; proximal junctional disease; sarcopenia.