The influence of sarcopenia on clinical and radiological features in patients with single-segment degenerative lumbar spondylolisthesis at L4/5 level.

Abstract

Purpose: Sarcopenia may be related to more severe clinical and radiological features; however, its influence on the patients with single-segment DLS at L4/5 level remains unclear. In the study, the impact of sarcopenia on clinical and radiological factors were investigated in patients with L4/5 degenerative lumbar spondylolisthesis (DLS).

Materials and methods: Patients diagnosed with single-segment DLS at L4/5 level were enrolled in the retrospective analysis based on a prospective, nonrandomized cohort dataset. According to our diagnostic process of sarcopenia, patients were classified into sarcopenia and non-sarcopenia groups. Clinical features including demographic characteristics, patient-reported outcome measures (PROMs) and clinician- reported outcome measures (ClinROMs) were collected. The radiological features included slip segment, percentage of slip (Slip%), translational motion, angular motion, dural sac cross-sectional area (DSA), ligamentum flavum thickness (LFT), paraspinal muscle parameters, and the use of grading systems to evaluate intervertebral discs, facet joints, and ligament degeneration.

Results: A total of 161 individuals were included, with 44 in the sarcopenia group and 117 in the non-sarcopenia group. Statistical analysis indicated that patients with sarcopenia exhibited significantly lower height, weight, body mass index (BMI), pain duration of back and leg, DSA, Japanese Orthopaedic Association scores (JOA), relative functional cross-sectional area (rfCSA) of psoas (PS) and erector spinae (ES) (P < 0.05). Additionally, the proportion of female, Oswestry Disability Index (ODI), LFT, Pfirrmann grading, percentage of fat infiltration (FI%) of ES in the sarcopenia group were significantly higher (P < 0.05). Multivariate logistic regression analysis showed a significant association between sarcopenia and ODI (OR 0.934, 95% CI 0.899-0.972), Slip% (OR 0.874, 95% CI 0.776-0.986), LFT (OR 0.501, 95% CI 0.288-0.872), and rfCSA of ES (OR 1.571, 95% CI 1.128-2.187).

Conclusion: Single-segment DLS patients at L4/5 level with sarcopenia suffered from greater pain and function impairment. In addition, more severe vertebral slippage and spinal stenosis were found, which may be linked to the degeneration of paraspinal muscles, intervertebral discs, and ligamentum flavum.