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

June 17, 2022

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 L ₃ level, SMI<45.4 cm ²/m ² (men) and SMI<34.4 cm ²/m ² (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 ( χ ²=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 ( χ ² =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.

目的:

探究肌肉减少症（简称肌少症）对传统腰椎后路开放手术治疗腰椎管狭窄症患者临床疗效的影响。.

方法:

回顾分析2017年8月—2020年12月符合选择标准的50例腰椎管狭窄症患者临床资料，依据欧洲老年人肌少症工作组（EWGSOP）的诊断标准，基于计算L ₃水平骨骼肌指数（skeletal muscle index，SMI），以SMI<45.4 cm ²/m ²（男性）和SMI>34.4 cm ²/m ²（女性）作为诊断阈值分为肌少症组（25例）和非肌少症组（25例）。两组患者性别、年龄、病程、腰椎管狭窄节段、手术融合节段、合并症等一般资料比较差异均无统计学意义（ P>0.05）；肌少症组患者身体质量指数明显低于非肌少症组，差异有统计学意义（ t=−3.198， P=0.002）。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间、并发症，术前及末次随访时腰痛和坐骨神经痛疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）；采用改良MacNab评定标准评价手术疗效。.

结果:

两组手术时间、术中出血量及术后引流量比较差异无统计学意义（ P>0.05）；肌少症组住院时间显著长于非肌少症组（ t=2.105， P=0.044）。两组患者均获随访，随访时间7～36个月，平均29.7个月。肌少症组术中出现硬膜撕裂及脑脊液漏1例、随访期间内固定物松动1例，两组各发生1例切口渗液、愈合不良，随访期间两组均未发生邻近节段退变及下肢深静脉血栓形成；两组并发症发生率（12% vs. 4%）比较差异无统计学意义（ χ ² =1.333， P=0.513）。末次随访时，两组患者腰痛及坐骨神经痛VAS评分和ODI评分均较术前显著改善（ P<0.05）。肌少症组患者腰痛VAS评分及ODI评分手术前后差值显著低于非肌少症组（ P<0.05），两组坐骨神经痛VAS评分手术前后差值比较差异无统计学意义（ t=−1.494， P=0.144）。按照改良MacNab评定标准评价疗效，肌少症组优良率为92%，非肌少症组优良率为96%，两组差异无统计学意义（ χ ²=1.201， P=0.753）。.