Sarcopenia in paraspinal muscle as a risk factor of proximal junctional kyphosis and proximal junctional failure after adult spinal deformity surgery

Jin Seong Park Department of Orthopedic Surgery, School of Medicine, Inha University, Jung-gu, Incheon, Korea

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Kyu Jung Cho Department of Orthopedic Surgery, School of Medicine, Inha University, Jung-gu, Incheon, Korea

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Jeong Seok Kim Department of Orthopedic Surgery, School of Medicine, Inha University, Jung-gu, Incheon, Korea

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Sung Jun Park Department of Orthopedic Surgery, School of Medicine, Inha University, Jung-gu, Incheon, Korea

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Hyeon Baek Department of Orthopedic Surgery, School of Medicine, Inha University, Jung-gu, Incheon, Korea

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OBJECTIVE

The aim of this study was to identify the risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy.

METHODS

Fifty-seven consecutive patients who underwent a long-instrumented fusion for adult spinal deformity (ASD) with a minimum follow-up of 2 years were included in the study. Patient, surgical, and radiological factors were evaluated. Muscle volume was measured using the muscle/vertebra ratio of the multifidus, erector spinae (ES), and psoas muscles, and muscle function was evaluated using the degree of fat infiltration at the L4–5 level.

RESULTS

The study included 57 consecutive patients: 25 patients in the combined PJK/PJF group (13 with PJK and 12 with PJF) and 32 in the control group (without PJK or PJF). The mean time to onset of PJK and PJF was 15.7 and 1.7 months, respectively. Multivariate analysis showed that greater pre- and postoperative sagittal vertical axis was associated with the occurrence of PJK/PJF. ES muscle atrophy was more significant in the PJK/PJF group than in the control group, and more severe in the PJF than in the PJK group.

CONCLUSIONS

This study showed that PJF occurred much earlier than PJK after ASD surgery. Paraspinal muscle atrophy was identified as a significant risk factor for PJK and PJF, especially PJF. The possibility of PJK and PJF development should be considered when long-segment fusion is planned for patients with paraspinal muscle atrophy.

ABBREVIATIONS

ASD = adult spinal deformity; BMD = bone mineral density; CSA = cross-sectional area; ES = erector spinae; FI = fat infiltration; LDK = lumbar degenerative kyphosis; LL = lumbar lordosis; MF = multifidus; PI = pelvic incidence; PI-LL = mismatch between PI and LL; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; PS = psoas; ROI = region of interest; SVA = sagittal vertical axis; UIV = upper instrumented vertebra; VB = vertebral body.
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Images from Özer and Demirtaş (pp 351–358).
  • 1

    Kim HJ, Yang JH, Chang DG, et al. Proximal junctional kyphosis in adult spinal deformity: definition, classification, risk factors, and prevention strategies. Asian Spine J. 2022;16(3):440450.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Park SJ, Lee CS, Chung SS, Lee JY, Kang SS, Park SH. Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 patients. Neurosurgery. 2017;80(2):279286.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Kim JS, Phan K, Cheung ZB, et al. Surgical, radiographic, and patient-related risk factors for proximal junctional kyphosis: a meta-analysis. Global Spine J. 2019;9(1):3240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Lau D, Clark AJ, Scheer JK, et al. Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. Spine (Phila Pa 1976). 2014;39(25):20932102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Yang J, Khalifé M, Lafage R, et al. What factors predict the risk of proximal junctional failure in the long term, demographic, surgical, or radiographic?: results from a time-dependent ROC curve. Spine (Phila Pa 1976). 2019;44(11):777784.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2014;11(3):177180.

  • 7

    Eleswarapu A, O’Connor D, Rowan FA, et al. Sarcopenia is an independent risk factor for proximal junctional disease following adult spinal deformity surgery. Global Spine J. 2022;12(1):102109.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y. Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine (Phila Pa 1976). 1988;13(11):13171326.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Hyun SJ, Lee BH, Park JH, Kim KJ, Jahng TA, Kim HJ. Proximal junctional kyphosis and proximal junctional failure following adult spinal deformity surgery. Korean J Spine. 2017;14(4):126132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Xia W, Fu H, Zhu Z, et al. Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. BMC Musculoskelet Disord. 2019;20(1):454.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Lee JC, Cha JG, Kim Y, Kim YI, Shin BJ. Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine (Phila Pa 1976). 2008;33(3):318325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5(1):2.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Gandhi SV, Januszewski J, Bach K, et al. Development of proximal junctional kyphosis after minimally invasive lateral anterior column realignment for adult spinal deformity. Neurosurgery. 2019;84(2):442450.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Protopsaltis TS, Diebo BG, Lafage R, et al. Identifying thoracic compensation and predicting reciprocal thoracic kyphosis and proximal junctional kyphosis in adult spinal deformity surgery. Spine (Phila Pa 1976). 2018;43(21):14791486.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Hyun SJ, Kim YJ, Rhim SC. Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J. 2016;16(9):10951101.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB. Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine (Phila Pa 1976). 2006;31(17):18881899.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Pezolato A, de Vasconcelos EE, Defino HLA, Nogueira-Barbosa MH. Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture. Eur Spine J. 2012;21(11):21582164.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Hadała M, Gryckiewicz S. The effectiveness of lumbar extensor training: local stabilization or dynamic strengthening exercises. A review of literature. Ortop Traumatol Rehabil. 2014;16(6):561572.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Kuo YK, Lin YC, Lee CY, et al. Novel insights into the pathogenesis of spinal sarcopenia and related therapeutic approaches: a narrative review. Int J Mol Sci. 2020;21(8):3010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Hunter GR, Singh H, Carter SJ, Bryan DR, Fisher G. Sarcopenia and its implications for metabolic health. J Obes. 2019;2019:8031705.

  • 21

    Lee KY, Lee JH, Im SK. Effect of gluteal muscle strengthening exercise on sagittal balance and muscle volume in adult spinal deformity following long-segment fixation surgery. Sci Rep. 2022;12(1):9063.

    • PubMed
    • Search Google Scholar
    • Export Citation

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