Effects of sarcopenia on the clinical efficacy of percutaneous vertebral augmentation in the treatment of osteoporotic thoracolumbar vertebral compression fracture

English Keywords:Sarcopenia  Osteoporosis  Spinal fractures  Percutaneous vertebral augmentation

English Abstract:

  【Abstract】 Objectives: To investigate the effects of sarcopenia on the clinical efficacy of percutaneous vertebral augmentation(PVA) in the treatment of osteoporotic thoracolumbar vertebral compression fracture(OTLVCF). Methods: We retrospectively analyzed the clinical data of 270 patients with OTLVCF who underwent PVA in the Second Affiliated Hospital, Air Force Military Medical University and Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2020 to December 2022. There were 109 males and 161 females; T10 vertebral fracture in 37 cases, T11 fracture in 52 cases, T12 fracture in 68 cases, L1 fracture in 72 cases, and L2 fracture in 41 cases. The patients were divided into sarcopenia group(52 cases) and non-sarcopenia group(218 cases) according to the diagnostic criteria of the European Working Group on Sarcopenia in Older People(EWGSOP), and using the dominant hand grip strength(<28.0kg) and the skeletal muscle index(SMI) at L3 level(<45.4cm2/m2) in male and the dominant hand grip strength(<18.0kg) and SMI at L3 level(<34.4cm2/m2) in female as the diagnostic thresholds. The general data(gender, age, height, weight, body mass fraction, fracture segment, strength of grasp and skeletal muscle index), operative data(surgical method, operative time, intraoperative blood loss, bone cement injection volume and intraoperative fluoroscopy times), and complications(cement leakage, refracture of injured vertebra, refracture of the adjacent vertebra and distal vertebral refracture) after operation of both groups of patients were collected. The visual analogue scale(VAS) and Oswestry disability index(ODI) were collected before operation and on postoperative 1d, at 1 month, 6 months and 1 year postoperatively and compared between the two groups. Results: There was no statistical difference in gender, height, weight, operative method, operative time, blood loss, bone cement injection volume, intraoperative fluoroscopy times, and preoperative VAS score and ODI between the two groups(P>0.05). The patients in the sarcopenia group were older(80.3±7.9 years vs 75.7±6.8 years, P<0.05) and had a smaller BMI(24.4±2.2kg/m2 vs 26.2±2.4kg/m2, P<0.05). The VAS score and ODI of the two groups on 1d and, at 1 month, 6 months and 1 year after operation were significantly improved compared with those before operation(P<0.05). At the same time, the VAS score and ODI in the sarcopenia group were significantly higher than those in the non-sarcopenia group on 1d and, at 1 month, 6 months and 1 year after operation(P<0.05). In terms of complications, there was no significant difference in the incidence of bone cement leakage between the two groups(9.65% vs 7.34%, P<0.05). The incidence of re-fracture of injured vertebrae, adjacent vertebrae and distal vertebrae and the total incidence of re-fracture within 1 year after operation in the sarcopenia group were significantly higher than those in the non-sarcopenia group(9.62% vs 2.75%, 13.46% vs 5.05%, 11.54% vs 4.13% and 33.61% vs 11.93%, P<0.05). Conclusions: The clinical effects of vertebral augmentation(PVA) in patients with sarcopenia are poorer than in non-sarcopenia OTLVCF patients, with higher vertebral re-fracture rates within 1 year after operation.