Lower psoas mass indicates worse prognosis in percutaneous vertebroplasty-treated osteoporotic vertebral compression fracture

Abstract

The correlation between lower psoas mass and the prognosis of osteoporotic vertebral compression fractures (OVCF) is still unclear. This study aims to investigate the impact of lower psoas mass on the prognosis of patients undergoing percutaneous vertebroplasty (PVP). One hundred and sixty-three elderly patients who underwent single-segment PVP from January 2018 to December 2021 were included. The psoas to L4 vertebral index (PLVI) via MRI were measured to assess psoas mass. Patients were divided into high PLVI (> 0.79) and low PLVI (≤ 0.79) groups based on the median PLVI in the cohort. The basic information (age, gender, body mass index (BMI) and bone mineral density (BMD)), surgical intervention-related elements (duration of operation, latency to ambulation, period of hospital stay, and surgical site), postoperative clinical outcomes (Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores), and incidence of secondary fractures) were compared. Patients showed no statistically significant differences in terms of age, gender, surgical sute, BMI, BMD and preoperative VAS, ODI, JOA scores (P > 0.05) between the two groups. However, there were significant differences in terms of latency to ambulation, period of hospital stay (P < 0.05). VAS, ODI, and JOA scores at 1, 6, and 12 months after surgery showed that the high PLVI group had significantly better outcomes than the low PLVI group (P < 0.05). Additionally, the low PLVI group had a significantly higher incidence of recurrent fracture (P < 0.05). Lower psoas mass can reduce the clinical effect of PVP in patients with osteoporotic vertebral compression fractures, and is a risk factor for recurrent vertebral fracture.

Keywords: Elderly; Osteoporotic vertebral compression fractures; Percutaneous vertebroplasty; Prognosis; Psoas mass.

Figure 1

The calculation of PLVI. PLVI = [right PCSA + left PCSA]/ L4 vertebral CSA. Left: the representative case of High PLVI, right: the representative case of Low PLVI. PLVI indicates psoas to L4 vertebral index, CSA indicates cross-sectional area, PCSA indicates psoas CSA.

Figure 2

Typical re-fracture case of central sarcopenia, a 72-year-old female patient. On April 25, 2019, fall caused back pain, and then DR (A), MR (B, C) were performed. After admission, PVP was performed, and DR Was reexamined after operation (D). Five months later, low back pain recurred, and a reexamination of MR revealed a L4 fracture (E). The patient was readmitted for PVP (F).