Impact of sarcopenia on postoperative clinical outcomes in patients with cervical spondylotic myelopathy undergoing anterior cervical discectomy and fusion.

OBJECTIVES

This study investigated the impact of sarcopenia diagnosed on the basis of the neck muscle index on the clinical efficacy of anterior cervical discectomy and fusion (ACDF) surgery in patients with cervical spondylotic myelopathy (CSM) 2 years after surgery.

METHODS

A retrospective analysis of the clinical data of 93 patients who underwent ACDF surgery for CSM between March 2019 and May 2023 was conducted. Patients meeting the sarcopenia diagnostic criteria of the C3 paraspinal muscle index (C3MI) for males and the sternocleidomastoid muscle index (SCMI) for females were divided into a sarcopenia group (38 patients) and a nonsarcopenia group (55 patients). Differences in the perioperative indicators, imaging data, and clinical efficacy scores between the two groups were compared.

RESULTS

Both groups of patients successfully underwent surgery, and no severe complications occurred postoperatively. In terms of baseline data and perioperative indicators, there were no statistically significant differences between the two groups in terms of sex, age, body mass index (BMI), intraoperative blood loss, surgical duration, preoperative odontoid incidence angle (OI), preoperative cervical spine range of motion (ROM), or preoperative adjacent segment ROM of the surgical segment (P > 0.05). Compared with preoperative values, both groups of patients demonstrated significant improvements in the T1 slope (T1s), C2‒C7 Cobb angle, C0‒C2 Cobb angle, sagittal segmental angle (SSA), and average surgical segment disc height (ASDH) immediately after surgery (P < 0.05). In terms of clinical functional scores, both groups of patients showed significant improvements in the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score, and neck disability index (NDI) score immediately after surgery and at the 2-year follow-up compared with the preoperative scores (P < 0.05). The VAS score and NDI score at 2-year post-surgery, as well as the VAS score immediately postsurgery, were significantly worse in the sarcopenia group than in the nonsarcopenia group (P < 0.05). In addition, there were no statistically significant differences in cervical spine parameters or changes in these parameters between the two groups postoperatively (P > 0.05).

CONCLUSIONS

Sarcopenia can have an adverse effect on pain relief and functional recovery in CSM patients undergoing ACDF surgery over a 2-year postoperative period. Clinicians should prioritize the assessment and intervention of sarcopenia in such patients to improve their long-term clinical outcomes following surgery.