Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures

Harald Krenzlin; Leon Schmidt; Dragan Jankovic; Carina Schulze; Marc A Brockmann; Florian Ringel; Naureen Keric

doi:10.3390/medicina58060748

Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures

Medicina (Kaunas). 2022 May 31;58(6):748. doi: 10.3390/medicina58060748.

Authors

Harald Krenzlin¹, Leon Schmidt¹, Dragan Jankovic¹, Carina Schulze¹, Marc A Brockmann², Florian Ringel¹, Naureen Keric¹

Affiliations

¹ Department of Neurosurgery, University Medical Center, 55131 Mainz, Germany.
² Department of Neuroradiology, University Medical Center, 55131 Mainz, Germany.

Abstract

Background and Objectives: Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). Materials and Methods: Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMA_HT). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). Results: A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (p = 0.77) but correlated with BMI (p = 0.005). The zSMA_HT was significantly lower in patients suffering from an IF (p = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459-13.04, p = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, p = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMA_HT (p = 0.0057) and BMD (p = 0.0041) were significantly related to IF occurrence. Conclusion: Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis.

Keywords: frailty; osteoporosis; sarcopenia; spondylodesis; vertebral fracture.

MeSH terms

Aged
Aged, 80 and over
Bone Density / physiology
Female
Humans
Lumbar Vertebrae / injuries
Male
Osteoporosis* / complications
Osteoporotic Fractures* / complications
Osteoporotic Fractures* / surgery
Sarcopenia* / complications
Sarcopenia* / pathology
Spinal Fractures* / complications
Spinal Fractures* / surgery

Grants and funding

This research received no external funding.