Associations between sarcopenia and degenerative lumbar scoliosis in older women

Abstract

BackgroundAge-related sarcopenia can cause various forms of physical disabilities. We investigated how sarcopenia affects degenerative lumbar scoliosis (DLS) and lumbar spinal canal stenosis (LSCS).MethodsSubjects comprised 40 elderly women (mean age 74 years) with spinal disease whose chief complaints were low back pain and lower limb pain. They included 15 cases of DLS (mean 74.8 years) and 25 cases of LSCS (mean age 72.9 years).We performed whole-body dual-energy X-ray absorptiometry (DXA) to analyze body composition, including appendicular and trunk skeletal muscle mass index (SMI; lean mass (kg)/height (m)2) and bone mineral density (BMD). A diagnostic criterion for sarcopenia was an appendicular SMI <5.46. To check spinal alignment, lumbar scoliosis (LS), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and vertebral rotational angle (VRA) were measured. Clinical symptoms were determined from the Japanese Orthopedic Association scores, low back pain visual analog scale, and Roland-Morris Disability Questionnaire (RDQ). Criteria for DLS were lumbar scoliosis >10° and a sagittal vertical axis (SVA) >50 mm. Sarcopenia prevalence, correlations between spinal alignment, BMD, and clinical symptoms with appendicular and trunk SMIs, and correlation between spinal alignment and clinical symptoms were investigated.ResultsDLS cases had significantly lower body weight, BMI, lean mass arm, and total lean mass than LSCS cases. Sarcopenia prevalence rates were 4/25 cases (16%) in LSCS and 7/15 cases (46.6%) in DLS, revealing a high prevalence in DLS. Appendicular SMIs were DLS 5.61 and LSCS 6.13 (p < 0.05), and trunk SMIs were DLS 6.91 and LSCS 7.61 (p < 0.01) showing DLS to have significantly lower values than LSCS. Spinal alignment correlations revealed the appendicular SMI was negatively correlated with PT (p < 0.05) and the trunk SMI was found to have a significant negative correlation with SVA, PT, LS, and VRA (p < 0.05). The trunk SMI was found to have a significant positive correlation with BMD (p < 0.05). As for clinical symptoms, RDQ was negatively correlated with appendicular SMI and positively correlated with PT (P < 0.05).ConclusionsSarcopenia complications were noted in 16% of LSCS patients and a much higher percentage, or 46.6%, of DLS patients. Appendicular and trunk SMIs were both lower in DLS, suggesting that sarcopenia may be involved in scoliosis. The appendicular skeletal muscle was related to posterior pelvic tilt, while the trunk muscle affected stooped posture, posterior pelvic tilt, lumbar scoliosis, and vertebral rotation. Decreases in trunk muscle mass were also associated with osteoporosis. Moreover, RDQ had a negative correlation with appendicular skeletal muscle mass and a positive correlation with PT, suggesting that sarcopenia may be associated with low back pain as a result of posterior pelvic tilt. Our research reveals for the first time how sarcopenia is involved in spinal deformations, suggesting decre...

Conservative Treatment of Degenerative Lumbar Scoliosis

“…Sarcopenia, which is a reduction in skeletal mass, is commonly seen in patients with DLS. Eguchi et al [26], using DEXA scans to assess the appendicular and trunk skeletal muscle mass, showed that sarcopenia was present in 46.6% of the DLS patients [26]. Sarcopenia is defined as the appendicular skeletal mass index of less than 5.46 kg/m 2 [27].…”

“…The appendicular skeletal mass index (ASMI) is the sum of the arm and leg lean mass (kg) divided by square of the height (m 2 ) [27]. Studies have also shown that ASMI negatively correlated with pelvic tilt [26], whereas trunk skeletal mass index (Trunk SMI) which is defined as trunk lean mass Spinal Deformities in Adolescents, Adults and Older Adults DOI: http://dx.doi.org /10.5772/intechopen.90052 divided by height 2 (m 2 ) significantly correlated with the sagittal vertical axis, pelvic tilt (PT), and lumbar scoliosis [26]. Moreover, trunk SMI correlated positively with bone mineral density (BMD), suggesting that reduction in trunk muscle mass was associated with osteoporosis and sagittal imbalance [26], which is prevalent in patients with DLS.…”

“…The body composition of the patient needs to be evaluated, when sarcopenia or loss of muscle mass with aging is suspected. Recent studies have shown that 46.6% of patients with DLS had reduced muscle mass involving the extremities and the trunk [26]. The trunk SMI was found to be significantly negatively correlated with sagittal vertical axis, pelvic tilt (PT), lumbar scoliosis, and apical vertebral rotation, suggesting that the reduction in trunk muscle mass was related to the stooped posture, pelvic retroversion, and lumbar scoliosis [26].…”

“…Apart from SSE to reduce the scoliosis angles, patients should be encouraged to perform exercises to improve muscle mass, as sarcopenia is prevalent in patients with DLS [26].…”

“…A study by Eguchi et al [26] showed that trunk skeletal muscle mass correlated positively with BMD [26]. The presence of sarcopenia would thus be indicative of osteoporosis [26]. Depending on the BMD, treatment by medication and/or nutritional supplementation may be required.…”