ArticleJournal of spine surgery (Hong Kong)2026
The impact of sarcopenia on proximal junctional kyphosis following long-segment spinal fusion for adult spinal deformity: a propensity score-matched cohort study.
Article in Journal of spine surgery (Hong Kong), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Preoperative Frailty Predicts Mechanical Complications After Adult Spinal Deformity Surgery: A Retrospective Study.Neurosurgery practice · 2026Article
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10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Proximal junctional kyphosis (PJK) remains a common mechanical complication following long-segment posterior spinal fusion for adult spinal deformity (ASD). While established risk factors include age, alignment, and bone quality, the role of paraspinal muscle degeneration has not been fully defined. This study aimed to evaluate the association between preoperative paraspinal muscle quantity and quality and the development of PJK after long-segment fusion for ASD. Methods: A retrospective propensity score-matched cohort study was performed including patients who underwent ≥5-level posterior spinal fusion for ASD between 2021 and 2023, all with a minimum of 2 years of clinical and radiographic follow-up. Propensity scores were estimated using logistic regression based on age, sex, body mass index (BMI), fusion levels and pedicle subtraction osteotomy (PSO), with 1:1 nearest-neighbor matching. Preoperative computed tomography (CT) scans were used to assess muscle cross-sectional area (CSA), skeletal muscle index (SMI), muscle-to-vertebra ratio (MVR), Hounsfield unit (HU) attenuation, and Goutallier grade at the L4 level and upper instrumented vertebra (UIV). Multivariate logistic regression was used to identify independent predictors of PJK. Results: Fifty-six patients were included after matching (28 PJK, 28 non-PJK). Patients with PJK demonstrated significantly lower SMI at L4, reduced CSA and MVR of the erector spinae and multifidus at both L4 and UIV levels, and worse muscle quality reflected by lower HU values and higher Goutallier grades (all P<0.05). Sarcopenia was more prevalent in the PJK group (53.6% Conclusions: Preoperative sarcopenia and paraspinal myosteatosis, particularly at the UIV, are strong independent predictors of PJK following long-segment fusion for ASD. Incorporating muscle assessment into preoperative risk stratification may improve prevention strategies for junctional failure.
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