Spine Deform. 2026 Apr 1. doi: 10.1007/s43390-026-01341-x. Online ahead of print.
ABSTRACT
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.
PMID:41920498 | DOI:10.1007/s43390-026-01341-x
