Paraspinal sarcopenia independently predicts patient-reported outcomes following open but not minimally invasive single-level lumbar decompression.

BACKGROUND CONTEXT: Sarcopenia is a known risk factor for inferior outcomes following spine surgery. However, few studies have investigated the optimal method or cutoff to quantify paraspinal sarcopenia on MRI for outcome prediction. Furthermore, no studies have compared the impact of paraspinal sarcopenia on outcomes after minimally invasive versus open decompression surgery.

PURPOSE: The objectives of this study were 1) to quantitatively measure sarcopenia of the lumbar paraspinal muscles on MRI to determine the impact on patient-reported outcomes (PROs) following minimally invasive surgery (MIS) versus open single-level lumbar decompression, and 2) to calculate an optimal cutoff for measurements of paraspinal sarcopenia that is predictive of achieving a minimum clinically important difference (MCID) in PROs.

STUDY DESIGN/

SETTING

Retrospective cohort.

PATIENT SAMPLE: Patients undergoing single-level lumbar decompression with MIS or open technique at an academic institution with a lumbar MRI within 1 year prior to surgery were identified.

OUTCOME MEASURES: Whether or not a minimum clinically important difference (MCID) was achieved 1 year postoperatively for Patient-Reported Outcome Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores.

METHODS

Demographic variables including age, sex, BMI, 5-factor modified frailty index (mFI-5), and operative level and length were collected. Measurements of the lumbar paraspinal muscles (eg, multifidus, psoas, and erector spinae) included the cross-sectional area (CSA) and fatty infiltration (FI). Demographic characteristics and paraspinal morphology were compared on bivariable and multivariable analyses between patients who met versus failed to meet an MCID of 8 on PROMIS-PF and -PI scores.

RESULTS

A total of 152 patients met the inclusion criteria for this study: 99 with MIS and 53 with an open surgical approach. For the MIS cohort, higher psoas FI was associated with less common achievement of MCID for PROMIS-PF (8.60%±4.31 vs 7.17%±5.08, p=.042) and -PI (8.74%±4.43 vs 7.23%±4.97, p=.038), and greater multifidus FI was associated with less common PROMIS-PF MCID achievement (28.2%±14.5 vs 21.1%±11.9, p=.010). However, these relationships did not persist after controlling for confounding variables. In the open laminectomy cohort, higher multifidus FI (32.8%±18.5 vs 22.4%±12.3, p=.040) and CSA (271mm2/m2±59.1 vs 234 mm2/m2±53.2, p=.041) and higher erector spinae (ES) FI (31.7%±15.5 vs 20.9%±10.5, p=.017) and CSA (850mm2/m2±184 vs 703mm2/m2±116, p=.008) were associated with less common achievement of MCID for PROMIS-PI. However, multivariable analysis revealed that only ES FI (odds ratio: 0.91, p=.045) was independently predictive of lower MCID achievement after controlling for baseline PROMIS-PI score, age, comorbidity burden (mFI-5), and operative level. An optimal cutoff of 31.9% ES FI was identified with an area under the curve (AUC) of 0.71, indicating moderate predictive value.

CONCLUSIONS

Paraspinal sarcopenia measured through fatty infiltration independently impacted PROs following open but not MIS single-level lumbar decompression. Specific attention may be given to the quality of the erector spinae muscles, especially with fatty infiltration above approximately 30%, when identifying patients who may be at risk for lesser pain improvement from surgery.