Abstract
Study Design: Retrospective observational study.Purpose: To comprehensively evaluate skeletal-muscle characteristics in patients with degenerative spondylolisthesis (DS), clarify the association between sarcopenia and DS, and determine the impact of sarcopenia on surgical outcomes.Overview of Literature: In lumbar spinal stenosis (LSS), factors such as spinal alignment, facet-joint orientation, and trunk muscle atrophy and fatty degeneration contribute to DS development. However, the role of sarcopenia in surgical outcomes in DS remains unclear.Methods: A cross-sectional analysis of 1,415 patients with LSS and L4–L5 stenosis (mean age 75.2±8.7 years; 703 males and 712 females) was performed to identify factors associated with Meyerding grade I or greater spondylolisthesis using sex-adjusted analysis of covariance and logistic regression. A longitudinal analysis of 373 patients who underwent surgery for LSS (mean age, 72.1±8.8 years; 200 males and 173 females) was conducted using the Asian Working Group for Sarcopenia algorithm to evaluate the effect of sarcopenia on 1-year postoperative outcomes.Results: Logistic regression analysis identified female sex, greater lumbar lordosis, lower skeletal-muscle mass index, smaller lumbar-multifidus (LM) cross-sectional area, smaller facet-joint angle, disc degeneration, smaller L4–L5 dural-sac area, and low flavum-canal ratio as significant variables associated with DS. No significant differences in the surgical outcomes were observed in LSS patients with and without DS, and no significant intergroup differences were noted in limb skeletal-muscle mass. However, both LM and erector spinae exhibited significantly more postoperative decreases in the DS group than in the non-DS group. No significant differences in skeletal-muscle mass change or surgical outcomes were observed according to sarcopenia status among DS patients.Conclusions: Sarcopenia is associated with DS, trunk muscle atrophy, and fatty degeneration. However, surgical treatment of patients with DS and sarcopenia yields favorable clinical outcomes because adequate decompression and stabilization may mitigate the impact of reduced skeletal-muscle mass.