Primary Research

Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy

Babu, Jacob M. MD, MHA^*; Wang, Kevin Y. BA^†; Jami, Meghana MPH^†; Durand, Wesley M. MD^†; Neuman, Brian J. MD^†; Kebaish, Khaled M. MD^†

Author Information

^*Illinois Bone & Joint Institute, 720 Florsheim Drive, Libertyville, IL

^†Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD

An individual with extensive statistical expertise, including the completion of the statistics for multiple peer-reviewed manuscripts, performed the statistics of this study. In addition, a team member that reviewed the statistical analysis for this study has a Master’s degree concentrated in epidemiology and biostatistics.

The data sets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

The authors declare no conflicts of interest.

Reprints: Meghana Jami, MPH, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287 (e-mail: [email protected]).

Clinical Spine Surgery 36(5):p 190-194, June 2023. | DOI: 10.1097/BSD.0000000000001455

Abstract

Study Design:

Retrospective cohort.

Objective:

The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity.

Summary of Background Data:

Sarcopenia is linked to morbidity and mortality in several orthopedic procedures. Data concerning sarcopenia in ASD surgery is limited, particularly with respect to complex techniques performed such as PSO. With the high surgical burden of PSOs, appropriate patient selection is critical for minimizing complications.

Methods:

We identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with spinal fusion ≥5 levels at a tertiary care center from 2005 to 2014. Sarcopenia was assessed by the psoas-lumbar vertebral index (PLVI). Using stratum-specific likelihood ratio analysis, patients were separated into 3 sarcopenia groups by complication risk. The primary outcome measure was any 2-year complication. Secondary outcome measures included intraoperative blood loss and length of stay.

Results:

The mean PLVI was 0.84±0.28, with 47% of patients having complications. Patients with a complication had a 27% lower PLVI on average than those without complications (0.76 vs. 0.91, P=0.021). Stratum-specific likelihood ratio analysis produced 3 complication categories: 32% complication rate for PLVI ≥ 0.81; 61% for PLVI 0.60–0.80; and 69% for PLVI < 0.60. Relative to patients with PLVI ≥ 0.81, those with PLVI 0.60–0.80 and PLVI < 0.60 had 3.2× and 4.3× greater odds of developing a complication (P<0.05). For individual complications, patients with PLVI < 1.0 had a significantly higher risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), while patients with PLVI < 0.8 had a significantly higher risk of wound infection (12% vs. 0%, P=0.028) and dural tear (14% vs. 0%, P=0.019). There were no significant associations between sarcopenia, intraoperative blood loss, and length of stay.

Conclusions:

The increasing severity of sarcopenia is associated with a significantly and incrementally increased risk of complications following ASD surgery that require PSO.

Level of Evidence:

Level III.

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Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy