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Matsuo S1, Minetama M1, Nakagawa M1, Yamamoto Y1, Koike Y1, Sakon N1, Nakatani T1, Sumiya T1, Nakagawa Y1, Teraguchi M1, Kagotani R1, Mera Y1, Kitano T1, Kawakami M1
1Wakayama Medical University Kihoku Hospital, Spine Care Center, Katsuragi-cho, Ito-gun, Japan
Background: Sarcopenia is a syndrome characterized by the progressive and systemic loss of skeletal muscle mass and strength. Physical inactivity is a primary factor in the progression of sarcopenia. Patients with lumbar spinal stenosis (LSS) often avoid walking and may have limited physical activity because of neurogenic claudication. Patients with LSS have a higher prevalence of sarcopenia than healthy older adults. However, the clinical features of sarcopenia in patients with LSS have been poorly studied.
Purpose: The purpose of this study was to identify factors associated with sarcopenia in patients with LSS using multimodal assessments.
Methods: This cross-sectional study, which was conducted at the Spine Care Center, Wakayama Medical University Kihoku Hospital, from September 2017 to April 2018, enrolled patients presenting with symptoms of neurogenic claudication caused by magnetic resonance imaging-confirmed LSS. Muscle mass was measured using bioelectrical impedance using the InBody S10 (BioSpace, Seoul, Korea). We collected data in regard to hand grip strength, 5-m gait speed, a numerical rating scale (NRS) of low back pain, leg pain and numbness, the 36-Iitem Short-Form Survey (SF-36), bone mineral density (BMD), and radiographic measurements (sagittal vertical axis, thoracic kyphosis, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, % slip, and number of vertebral fractures). Sarcopenia was defined according to the guidelines of the Asian Working Group for Sarcopenia (hand grip strength 26 kg for men and 18 kg for women and/or gait speed 0.8 m/s and skeletal muscle mass index [SMI] 7.0 kg/m2 for men and 5.7 kg/m2 for women). Patients were classified into sarcopenia and nonsarcopenia groups. P-values 0.05 were considered significant.
Results: In total, 147 patients (average age: 73.6 y; 63 men, 84 women) were enrolled, 29 of whom (average age: 79.5 y; 9 men, 20 women) were classified into the sarcopenia group and 117 (average age: 73.0 y; 53 men, 64 women) into the nonsarcopenia group. The prevalence of sarcopenia was 19.9%. The average age of patients in the sarcopenia group was significantly higher than that of those in the nonsarcopenia group (P 0.001). Height, body mass index, limb and trunk muscle mass, SMI, hand grip strength, gait speed, femoral neck BMD, and physical function as assessed by the SF-36 were significantly lower in the sarcopenia than in the nonsarcopenia group (P 0.05). A trend was observed toward a difference between groups in back pain as assessed by the NRS (sarcopenia group: 5.5 points vs nonsarcopenia group: 4.4 points; P = 0.068).
Conclusion(s): Patients with LSS and sarcopenia had lower muscle mass and strength, physical performance, and physical function than those without sarcopenia and reported more severe low back pain. Thus, sarcopenia may be associated with low back pain in patients with LSS.
Implications: Upper and lower limb-strengthening exercises might be effective for the treatment of low back pain in patients with LSS. Because patients with LSS have a high prevalence of sarcopenia, they require interventions aimed at increasing physical activity and changing lifestyle and dietary habits.
Keywords: Sarcopenia, lumbar spinal stenosis, low back pain
Funding acknowledgements: We have no funding in this study.
Purpose: The purpose of this study was to identify factors associated with sarcopenia in patients with LSS using multimodal assessments.
Methods: This cross-sectional study, which was conducted at the Spine Care Center, Wakayama Medical University Kihoku Hospital, from September 2017 to April 2018, enrolled patients presenting with symptoms of neurogenic claudication caused by magnetic resonance imaging-confirmed LSS. Muscle mass was measured using bioelectrical impedance using the InBody S10 (BioSpace, Seoul, Korea). We collected data in regard to hand grip strength, 5-m gait speed, a numerical rating scale (NRS) of low back pain, leg pain and numbness, the 36-Iitem Short-Form Survey (SF-36), bone mineral density (BMD), and radiographic measurements (sagittal vertical axis, thoracic kyphosis, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, % slip, and number of vertebral fractures). Sarcopenia was defined according to the guidelines of the Asian Working Group for Sarcopenia (hand grip strength 26 kg for men and 18 kg for women and/or gait speed 0.8 m/s and skeletal muscle mass index [SMI] 7.0 kg/m2 for men and 5.7 kg/m2 for women). Patients were classified into sarcopenia and nonsarcopenia groups. P-values 0.05 were considered significant.
Results: In total, 147 patients (average age: 73.6 y; 63 men, 84 women) were enrolled, 29 of whom (average age: 79.5 y; 9 men, 20 women) were classified into the sarcopenia group and 117 (average age: 73.0 y; 53 men, 64 women) into the nonsarcopenia group. The prevalence of sarcopenia was 19.9%. The average age of patients in the sarcopenia group was significantly higher than that of those in the nonsarcopenia group (P 0.001). Height, body mass index, limb and trunk muscle mass, SMI, hand grip strength, gait speed, femoral neck BMD, and physical function as assessed by the SF-36 were significantly lower in the sarcopenia than in the nonsarcopenia group (P 0.05). A trend was observed toward a difference between groups in back pain as assessed by the NRS (sarcopenia group: 5.5 points vs nonsarcopenia group: 4.4 points; P = 0.068).
Conclusion(s): Patients with LSS and sarcopenia had lower muscle mass and strength, physical performance, and physical function than those without sarcopenia and reported more severe low back pain. Thus, sarcopenia may be associated with low back pain in patients with LSS.
Implications: Upper and lower limb-strengthening exercises might be effective for the treatment of low back pain in patients with LSS. Because patients with LSS have a high prevalence of sarcopenia, they require interventions aimed at increasing physical activity and changing lifestyle and dietary habits.
Keywords: Sarcopenia, lumbar spinal stenosis, low back pain
Funding acknowledgements: We have no funding in this study.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Wakayama Medical University
Ethics committee: Institutional Review Broard of Wakayama Medical University
Ethics number: 2378
All authors, affiliations and abstracts have been published as submitted.
