Related Experiment Video
Updated: Jul 10, 2026
Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
Published on: July 15, 2021
Sarcopenia Predicts Early Adjacent Segment Disease Development After Anterior and Oblique Lumbar Interbody Fusion
Brandon M Wilkinson1, Raahim Bashir, Brendan B Maloney
1Department of Neurosurgery, SUNY Upstate Medical University, Syracuse , New York , USA.
Background And Objectives:
Sarcopenia has recently been shown to increase risk of early adjacent segment disease (ASD) development after transforaminal lumbar interbody fusion. We sought to evaluate whether sarcopenia increases risk of ASD after retroperitoneal approaches for lumbar interbody fusion (eg, anterior lumbar interbody fusion or oblique lateral lumbar interbody fusion).
Methods:
Retrospective data were collected from 104 adult patients aged older than 18 years who underwent short-segment fusion through anterior lumbar interbody fusion or oblique lateral lumbar interbody fusion approach from 2013 to 2023. The primary outcome was development of ASD within 3 years of surgery. Patients who had prior surgery for ASD, underwent long-construct deformity correction, had an ongoing oncological process, or lacked sufficient follow-up were excluded. Psoas and vertebral body volumetric measurements were calculated at the L4 pedicle level using preoperative MRI. Spinopelvic parameters of pelvic tilt, pelvic incidence (PI), lumbar lordosis (LL), and PI-LL mismatch were recorded from standing upright radiographs. Odds ratios were calculated with logistic regression analyses.
Results:
Of 104 patients undergoing fusion through retroperitoneal approaches, 25 (24.04%) developed ASD within 3 years. Patient demographics and medical comorbidities did not predict early ASD. Left and right psoas area (cm 2 ) and psoas:vertebral body ratio strongly predicted ASD development ( P < .0001). Nineteen patients were categorized as sarcopenic, defined as bilateral psoas:vertebral body ratios >1 SD below the study population gender mean. 16 of the 19 sarcopenic patients developed ASD within 3 years, compared with 9 of the 85 nonsarcopenic patients (84.21% vs 10.59%, P < .0001). Postoperative pelvic tilt and PI-LL mismatch were predictive of ASD on univariate but not multivariate analysis.
Conclusion:
Sarcopenia significantly predicts ASD development within 3 years after lumbar fusion through retroperitoneal approaches. Irrespective of approach, sarcopenia is a risk factor of ASD formation and should be evaluated preoperatively. Morphometric analysis provides a simple screening tool and can be used to tailor preoperative and postoperative therapies to improve outcomes.
