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Full-Body Radiographic Imaging-Based Thigh Muscle Measurement for Sarcopenia: Association with Functional Assessments
Joseph E Nassar1, Michael J Farias1, Richard Hostin2
1Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island.
Spine
|June 25, 2026
Summary
Sarcopenia in adult spinal deformity (ASD) patients is linked to frailty and poorer outcomes. EOS-derived thigh measurements can identify sarcopenia, aiding surgical planning and patient management.
Area of Science:
- Orthopedics and Spine Surgery
- Geriatrics
- Radiology
Background:
- Adult spinal deformity (ASD) patients often exhibit sarcopenia, a condition linked to reduced muscle mass and strength, negatively impacting surgical outcomes.
- Routine full-body EOS (Ensemble of Systems) radiographs offer a cost-effective, low-radiation method for opportunistic thigh muscle measurements.
- This study investigates the utility of EOS-derived thigh and quadriceps measurements in identifying sarcopenia and its influence on compensatory mechanisms in ASD.
Purpose of the Study:
- To evaluate the effectiveness of EOS-derived thigh muscle measurements as indicators of sarcopenia in adult spinal deformity (ASD) patients.
- To assess the impact of sarcopenia, identified via EOS measurements, on compensatory mechanisms within the spine and lower extremities.
- To correlate EOS-derived muscle measurements with clinical indicators of frailty and functional status.
Main Methods:
- A multicenter retrospective cohort study analyzed prospectively collected data from 24 spine centers (2019-2024).
- Sarcopenia was diagnosed using validated, sex-specific EOS cutoffs for both anterior-posterior (AP) thigh and lateral (LAT) quadriceps measurements.
- Clinical frailty scores, grip strength, timed up and go (TUG) tests, and epigenetic age were compared between sarcopenic (SARCO) and non-sarcopenic (NON-SARCO) patients.
Main Results:
- Of 540 ASD patients, 11.3% were classified as sarcopenic (SARCO).
- SARCO patients exhibited lower BMI, higher clinical frailty scores, and slower TUG times compared to NON-SARCO patients (P<0.05).
- Smaller thigh and quadriceps thickness, and sarcopenia status, correlated with increased frailty, weaker grip strength, slower TUG, and older epigenetic age (P<0.05). Sarcopenia was associated with greater thoracic kyphosis, cervical lordosis, sagittal vertical axis, and knee flexion angle (P<0.05).
Conclusions:
- EOS-derived thigh muscle measurements are significant indicators of frailty, grip strength, TUG performance, and epigenetic age in ASD patients.
- Sarcopenic ASD patients display altered compensatory mechanisms, including impaired proximal and increased distal adjustments.
- Integrating EOS-derived muscle thickness measurements into preoperative assessments can enhance surgical planning and patient management for ASD.
