Related Experiment Video
Updated: Apr 2, 2026
Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
Radiographic paraspinal muscle size in adult spinal deformity: a systematic review and meta-analysis
Kento Yamanouchi1,2, Rafael Garcia de Oliveira1, Iyan Younus1
1Center for Neuroscience and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
Purpose:
Reduced trunk muscle quantity or quality, commonly assessed using imaging-based metrics, has been associated with adverse outcomes in spine surgery. However, evidence specific to adult spinal deformity (ASD) surgery remains heterogeneous and methodologically limited. This systematic review aimed to synthesize existing muscle metrics and surgical outcomes in patients undergoing ASD surgery.
Methods:
A systematic search of PubMed and EMBASE was performed to identify studies evaluating imaging-based muscle quantity or quality in adult patients (≥ 18 years) undergoing thoracolumbar corrective surgery. Eligible studies employed radiographic measures of muscle status. Outcomes of interest were postoperative complications, reoperation, readmission, length of stay (LOS), and patient-reported outcome measures (PROMs). Data were extracted based on study design, patient demographics, surgical characteristics, and follow-up. Meta-analysis was conducted using Review Manager 5.4, with odds ratios (ORs) for dichotomous outcomes and mean differences for continuous outcomes.
Results:
Fifteen studies met the eligibility criteria in this review. Meta-analysis demonstrated substantial heterogeneity across studies, particularly for proximal junctional kyphosis (PJK) and length of stay (LOS), limiting the interpretability of pooled estimates. No statistically significant differences were observed for reoperation, readmission, wound complications, or patient-reported outcomes. A modest increase in LOS was observed in patients with lower muscle metrics, although this finding was highly heterogeneous and may reflect residual confounding.
Conclusion:
Current evidence examining imaging-based muscle metrics in ASD surgery is characterized by substantial heterogeneity and predominantly retrospective study designs. While reduced muscle quantity or quality may be associated with postoperative outcomes, existing data do not support definitive conclusions or causal inferences. These findings highlight the need for standardized muscle assessment methods and prospective studies incorporating validated sarcopenia criteria to better clarify the clinical relevance of muscle health in ASD surgery.
