Clinical study of preoperative skeletal muscle mass as a predictor of physical performance recovery following palliative surgery for spinal metastases

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2023-07, Vol.28 (4), p.874-879
• Main Authors: Ushiku, Chikara, Akiyama, Shoshi, Ikegami, Taku, Inoue, Takeshi, Shinohara, Akira, Kobayashi, Shunsuke, Kajiwara, Takayoshi, Arimura, Daigo, Katsumi, Shunsuke, Obata, Shintaro, Soshi, Shigeru, Saito, Mitsuru
• Format: Article
• Language: English
• Subjects: Humans; Lumbar Vertebrae - pathology; Lumbar Vertebrae - surgery; Muscle, Skeletal - pathology; Palliative Care; Palliative surgery; Physical performance; Psoas major muscle; Psoas Muscles - diagnostic imaging; Psoas Muscles - pathology; Retrospective Studies; Sarcopenia; Sarcopenia - complications; Spinal metastasis; Spinal Neoplasms - complications; Spinal Neoplasms - surgery
• ISSN: 0949-2658; 1436-2023
• DOI: 10.1016/j.jos.2022.06.006

Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass. We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses. The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610–149.00, P