Photo Credit: Pornpak Khunatorn
The following is a summary of “Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy,” published in the June 2023 issue of Spinal Disorders and Techniques by Babu et al.
The design of the study was a retrospective cohort. The purpose of this study was to determine whether sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and to define categories of complication risk according to sarcopenia severity. Several orthopedic procedures are associated with an increased risk of morbidity and mortality in patients with sarcopenia. There is limited data regarding sarcopenia in ASD surgery, particularly complex techniques such as PSO. Due to the high surgical volume associated with PSOs, patient selection is crucial for minimizing complications.
Between 2005 and 2014, researchers identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with a spinal fusion of 5 levels at a tertiary care center. The psoas-lumbar vertebral index (PLVI) was utilized to assess sarcopenia. Using stratum-specific likelihood ratio analysis, patients with sarcopenia were divided into three categories based on the risk of complications. The primary outcome measure was any complication at two years. In addition to intraoperative blood loss and duration of stay, secondary outcome measures were intraoperative blood loss and length of stay. The mean PLVI was 0.840.28, with complications occurring in 47% of patients. Those with difficulties had an average PLVI of 27% lower than those without complications (0.76 versus 0.91, P=0.021).
The stratum-specific likelihood ratio analysis generated three complication categories: 32% complication rate for PLVI 0.81, 61% for PLVI 0.60–0.80, and 69% for PLVI< 0.60. Compared to patients with PLVI 0.81, those with PLVI 0.60–0.80 and PLVI <0.60 had 3.2 and 4.3 times the likelihood of developing a complication, respectively (P<0.05). Patients with PLVI <1.0 had a significantly increased risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), whereas patients with PLVI <0.8 had a significantly increased risk of wound infection (12% vs. 0%, P=0.028) and dural injury (14% vs. 0%, P=0.019). There were no statistically significant relationships between sarcopenia, intraoperative blood loss, and length of hospital stay. The severity of sarcopenia is associated with a substantially and incrementally increased risk of complications necessitating PSO following ASD surgery.
