Cervical paraspinal sarcopenia affects ability to achieve PROMIS minimal clinically important difference in patients undergoing anterior cervical discectomy and fusion.

INTRODUCTION

Sarcopenia is an established risk factor for poor outcomes in the general surgery literature; however, this has been less explored in spine surgery. No studies have quantified cervical paraspinal sarcopenia on magnetic resonance imaging (MRI) to determine the influence on postoperative patient improvement as measured through PROMIS scores. The objective of this study was to determine the influence of cervical sarcopenia on PROMIS score improvement following anterior cervical discectomy and fusion (ACDF).

METHODS

Patients over 18 years of age who underwent ACDF at a single, tertiary academic institution between 2012 and 2018 were included in the study. Multifidus fatty infiltration (FI) and cross-sectional area (CSA) were quantified on preoperative MRI measurements. PROMIS-physical function (PF) and pain interference (PI) scores were collected at baseline and 1-year postoperatively and compared with a minimal clinically important difference (MCID) of 4.5 for PF and 4.9 for PI. Bivariate and multivariate analyses compared FI and CSA in patients who met versus failed to meet the MCID for PF and PI components.

RESULTS

Seventy-eight patients met the inclusion criteria. The mean age was 54.8, and 29 were female. MCID was achieved in 46 patients for PROMIS-PF and 42 for PROMIS-PI. Greater multifidus FI demonstrated a significant association with increased likelihood of meeting PF MCID on bivariate (P = 0.043) and multivariate (P = 0.033). Multifidus CSA was not associated with meeting the MCID for PF or PI. No correlation was found between multifidus CSA and FI (r 2 = 0.0797).

CONCLUSIONS

Higher multifidus FI was independently associated with meeting MCID for PROMIS-PF scores 1 year following ACDF.