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The Magnetic Resonance Imaging of the Psoas Muscle Area as the Prognostic Factor for Survival and Adverse Events in
Kitidate Boonchai1, Borriwat Santipas1, Sirichai Wilartratsami1
1Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Study Design:
Retrospective study.
Objective:
This study aimed to evaluate the ability of the mortality and adverse events prediction following metastatic spinal surgery of MRI-based cross-sectional psoas muscle area (PMA).
Methods:
A retrospective chart review, 120 patients who had undergone metastatic spinal surgery were included. The cross-sectional area identified the PMA under MR-imaging at the L3 or L4 pedicle level, which was classified into 3 tertiles. We used univariate and multivariate cox proportional hazard regression to assess whether PMA was associated with 30-day, 90-day, 1-year, and overall mortality.
Results:
The small psoas tertile group populations had a higher mortality rate than the large psoas tertile group. PMA in T1 and T2 had a probability of a higher 90-d mortality rate than PMA in T3 (T1 VS T3: P = .29 and T2 VS T3: P = .12). The median survival time was 7 months, 9 months, and 10 months in PMA T1, T2, and T3, respectively. PMA in tertile 2 had a significantly higher mortality rate of 38% compared to PMA in tertile 3 (HR 1.38, 95% CI .83-2.32, P = .02). Considering PMA as a continuous variable, every 1 mm2 increment of PMA resulted in the increase survivorship of 1% (HR .99 with 95% CI .99-1).
Conclusion:
The MRI-based cross-sectional PMA tends to predict the 90-d mortality rate and overall mortality rate in spinal metastasis patients who underwent spinal surgery. The PMA should be considered one of the prognostic factors in the treatment of metastatic spinal patients.
Insights
This study found that psoas muscle area (PMA) measured by MRI can help predict mortality after spinal surgery for metastatic cancer. Smaller PMA is associated with higher mortality rates, suggesting it
Area of Science:
- Oncology
- Orthopedics
- Radiology
Background:
- Metastatic spinal disease is a common complication of cancer.
- Surgical intervention is often necessary but carries significant risks.
- Predictive factors for patient outcomes are crucial for treatment planning.
Purpose of the Study:
- To evaluate the predictive ability of MRI-based cross-sectional psoas muscle area (PMA) for mortality and adverse events following metastatic spinal surgery.
- To determine if PMA can serve as a prognostic factor in patients undergoing this procedure.
Main Methods:
- Retrospective chart review of 120 patients who underwent metastatic spinal surgery.
- Measurement of cross-sectional PMA at L3 or L4 pedicle level using MR-imaging.
- Analysis of PMA association with 30-day, 90-day, 1-year, and overall mortality using Cox proportional hazard regression.
Main Results:
- Patients with smaller PMA tertiles exhibited higher mortality rates.
- PMA tertile 2 showed a significantly higher 90-day mortality rate (38%) compared to tertile 3.
- Each 1 mm² increment in PMA correlated with a 1% increase in survivorship.
Conclusions:
- MRI-based cross-sectional PMA is a potential predictor of 90-day and overall mortality in spinal metastasis patients.
- PMA should be considered a significant prognostic factor in managing patients with metastatic spinal disease.
