Introduction: Subsequent osteoporotic vertebral fractures (SOVF) are a serious complication of osteoporosis that can lead to spinal deformity, chronic pain and disability. Several risk factors have been previously identified for developing SOVF. However, there are conflicting reports regarding the association between sarcopenia and multiple vertebral compression fractures. As such, the goal of this study was to investigate whether sarcopenia is an independent risk factor of SOVF. Methods: This was a retrospective case–control study of elderly patients who underwent percutaneous vertebral augmentation (PVA) due to a new osteoporotic vertebral compression fracture (OVCF). Collected data included: age, sex, BMI, steroid treatment, fracture level and type, presence of kyphosis at the level of the fracture and bone mineral density (BMD). Identification of SVOFs was based on clinical notes and imaging corroborating the presence of a new fracture. Sarcopenia was measured using the normalized psoas muscle total cross-sectional area (nCSA) at the L4 level. Results: Eighty-nine patients that underwent PVA were followed for a minimum of 24 months. Average age was 80.2 ± 7.1 years; 58 were female (65.2%) and 31 male (34.8%). Psoas muscle nCSA was significantly associated with age (p = 0.031) but not with gender (p = 0.129), corticosteroid treatment (p = 0.349), local kyphosis (p = 0.715), or BMD (p = 0.724). Sarcopenia was significantly associated with SOVF (p = 0.039) after controlling for age and gender. Conclusions: Psoas muscle nCSA can be used as a standalone diagnostic tool of sarcopenia in patients undergoing PVA. In patients undergoing PVA for OVCF, sarcopenia is an independent risk factor for SOVF.

In order to improve outcomes for patients with lumbar spinal stenosis, identification of better prognostic factors is necessary to guide patient selection for surgery. The purpose of this study was to investigate the prognostic value of multifidus atrophy and sarcopenia on postoperative pain and disability following minimally invasive decompression for lumbar spinal stenosis. We retrospectively reviewed medical records and imaging studies for patients with lumbar spinal stenosis who underwent minimally invasive tubular decompression. Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify predictors of postoperative improvement in visual analogue scores for back pain (VASB) and leg pain (VASL) and Oswestry disability index (ODI) scores for disability. Minimally invasive decompression was performed at 75 spinal levels in 64 patients with an average age of 70.1±10.0 years. In multivariable analysis, lower multifidus FI was significantly associated with 5 point improvement in ODI (p=.002), 10 point improvement in ODI (p=.017), and 17 point improvement in ODI (p=.044). Only male gender (p=.030), lower preoperative VASB (p=.001), and lower preoperative VASL (p=.015) were independently predictive of postoperative deterioration in ODI, VASB, and VASL, respectively. Multifidus FI predicts postoperative improvement in disability following minimally invasive decompression for lumbar spinal stenosis with high accuracy. Minimally invasive decompression surgery is effective for elderly patients and sarcopenic patients, who are not at risk for poorer postoperative outcomes. Male gender and lower preoperative pain or disability are risk factors for postoperative deterioration in patient-reported outcomes.

Background: Cauda Equina syndrome (CES) is a potentially devastating condition and is treated usually with urgent open surgical decompression of the spinal canal. Currently, the role of minimally invasive discectomy (MID) as an alternative surgical technique for CES is unclear.Objective: The purpose of this study was to compare clinical outcomes following MID and open laminectomy and discectomy for the treatment of CES.Methods: The study cohort included patients that underwent surgery due to CES at our institute. Patients' outcomes included: surgical complications, length of hospitalization, postoperative lower extremity motor score (LEMS), Numerical Rating Scale (NRS) for leg and back pain, Oswestry disability index (ODI), and the EQ-5D health-related quality of life questionnaire.Results: Twelve patients underwent MID and 12 underwent open laminectomy and discectomy. Complications and revisions rates were comparable between the groups. Postoperative urine incontinence and saddle dysesthesia improved in 50% of patients in both groups. LEMS improved from 47.08 ± 5.4 to 49.27 ± 0.9 in the MID group and from 44.46 ± 5.9 to 49.0 ± 1.4 in the open group. Although, leg pain improved in both groups from 8.4 ± 2.4 to 3 ± 2.1 in the MID and from 8.44 ± 3.3 to 3.88 ± 3 in the open group, significant improvement in back pain was found only in the MID group. Final functional scores were similar between groups.Conclusions: Our preliminary results suggest that minimally invasive discectomy is an effective and safe procedure for the treatment of CES when compared to open laminectomy and discectomy. However, MID in these cases should only be considered by surgeons experienced in minimally invasive spine surgery. Further studies with bigger sample sizes and long-term follow-ups are needed.