Leon Schmidt (Mainz), Harald Krenzlin (Mainz), Dragan Jankovic (Mainz), Florian Ringel (Mainz), Naureen Keric (Mainz)
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Objective: Age-related loss of bone and muscle mass are signs of frailty and associated with increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determine the impact of sarcopenia and bone density on implant failure (IF) and complications in patients with spondylodesis due to low-impact vertebral fractures.
Methods: Patients diagnosed with low-impact fractures 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 optimal height and body mass index (BMI)adjustment (zSMAHT). Loss of muscle function was assessed by measurement of myosteatosis (skeletal muscle radiodensity, SMD) on axial CT scans. Bone mineral density (BMD) was determined at L3 in Houndsfield Units (HUs).
Results: 68 patients with low-impact vertebral fractures underwent instrumentation in 202 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). zSMAHT was significantly lower in patients suffering from 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 IF. Using multivariate analysis revealed that zSMAHT is significantly related to IF occurrence (p=0.004).
Conclusion: Herein, we established sarcopenia-obesity as the main determinant for the occurrence of IF after instrumentation for low-impact fractures. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring SMA and BMD using axial CT of the lumbar spine might help preventing IF in spinal fusion surgery by early detection and treatment of sarcopenia and osteoporosis.