Sarcopenia as a predictor of poor functional outcome of cervical spine surgery: a systematic review and meta-analysis

Sarcopenia is a progressive loss of muscle mass. This study aims to determine the association of pre-operative sarcopenia with the outcome of cervical spine surgery. Pubmed, Ovid, Embase, and Web of Sciences databases were searched until September 2023 to include articles regarding the prognostic role of preoperative sarcopenia in cervical spine surgery patients. The Quality In Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Meta-analyses Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The vote-counting model was used for the qualitative appraisal of the studies. Statistical analysis was performed with a significant p < 0.05 using SPSS software (version 23). Of the 1,134 articles revealed from the search, 15 studies with 1463 patients were included. A significant difference between patients with and without sarcopenia was not found for the occurrence of loss of lordosis (OR = 1.28, 95%CI = 0.21 to 7.62, p = 0.6137), and deterioration of the Neck disability index postoperatively (OR = 1.53, 95%CI = 0.0 to 632.04, p = 0.7914). In the vote-counting model, there was strong evidence that sarcopenia worsens postoperative patient-reported outcomes and spine stability, while evidence was conflicting on whether sarcopenia can affect the occurrence of surgical complications. Sarcopenia may predispose cervical spine surgery patients to a worse surgical outcome as compared to non-sarcopenic patients, and it can be used to prognosticate the patients.