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Decreased muscle mass and strength affected spinal sagittal malalignment

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Abstract

Purpose

Correction surgeries for spinal malalignment showed good clinical outcomes; however, there were concerns including increased invasiveness, complications, and impact on medico-economics. Ideally, an early intervention is needed. To better understand the patho-mechanism and natural course of spinal alignment, the effect of factors such as muscle mass and strength on spinal sagittal imbalance were determined in a multicenter cross-sectional study.

Methods

After excluding metal implant recipients, 1823 of 2551 patients (mean age: 69.2 ± 13.8 years; men 768, women 1055) were enrolled. Age, sex, past medical history (Charlson comorbidity index), body mass index (BMI), grip strength (GS), and trunk muscle mass (TM) were reviewed. Spinal sagittal imbalance was determined by the SRS-Schwab classification. Multiple comparison analysis among four groups (Normal, Mild, Moderate, Severe) and multinomial logistic regression analysis were performed.

Results

On multiple comparison analysis, with progressing spinal malalignment, age in both sexes tended to be higher; further, TM in women and GS in both sexes tended to be low. On multinomial logistic regression analysis, age and BMI were positively associated with spinal sagittal malalignment in Mild, Moderate, and Severe groups. TM in Moderate and Severe groups and GS in the Moderate group were negatively associated with spinal sagittal malalignment.

Conclusion

Aging, obesity, low TM, and low GS are potential risk factors for spinal sagittal malalignment. Especially, low TM and low GS are potentially associated with more progressed spinal sagittal malalignment. Thus, early intervention for muscles, such as exercise therapy, is needed, while the spinal sagittal alignment is normal or mildly affected.

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Acknowledgements

We thank Motoki Makabe, Yukie Arai, Kazue Takakura, and Ikumi Sekihara for their assistance with this study.

Funding

This investigation was supported in part by JOA-Subsidized Science Project Research 2018-2.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Masayuki Miyagi, Gen Inoue, Kosuke Murata, Ayumu Kawakubo, Hisako Fujimaki, Tomohisa Koyama, Yuji Yokozeki, Yusuke Mimura, Eiki Shirasawa, Wataru Saito, Takayuki Imura, Toshiyuki Nakazawa, Kentaro Uchida & Masashi Takaso

  2. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Yusuke Hori, Shinji Takahashi, Shoichiro Ohyama, Hidetomi Terai, Masatoshi Hoshino, Akinobu Suzuki, Hiromitsu Toyoda & Hiroaki Nakamura

  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Kazuhide Inage, Sumihisa Orita, Yawara Eguchi, Yasuhiro Shiga, Takeo Furuya, Satoshi Maki & Seiji Ohtori

  4. Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan

    Tadao Tsujio & Sho Dohzono

  5. Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan

    Ryuichi Sasaoka

  6. Center for Frontier Medical Engineering, Chiba University, Chiba, Japan

    Sumihisa Orita

Authors
  1. Masayuki Miyagi
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Contributions

MM drafted the manuscript and participated in the design of the study. IG, HY, and IK helped to revise the manuscript, MK, KA, FH, KT, YY, MY, TS, OS, TH, HM, SA, TT, DS, SR, TH, OS, EY, SY, FT, and MS collected the clinical data, SE, SW, IT, NT, and KU carried out the data analysis, and OS, NH, and TM conceived the study and participated in its design and coordination. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Masayuki Miyagi.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethics approval

Ethical approval from the Institutional Review Board in Kitasato University was obtained for this study, which was conducted in accordance with the ethical principles specified in the 1964 Declaration of Helsinki and its later amendments. Approval code is B18-086.

Consent to participate

The requirement for informed consent was waived.

Availability of data and material

The data are available on reasonable request to the corresponding author.

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Miyagi, M., Inoue, G., Hori, Y. et al. Decreased muscle mass and strength affected spinal sagittal malalignment. Eur Spine J 31, 1431–1437 (2022). https://doi.org/10.1007/s00586-022-07151-9

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  • DOI: https://doi.org/10.1007/s00586-022-07151-9

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