Spine - 2026-08-19 - Journal Article
Effects of Sarcopenia on Surgical Outcomes After Biportal Endoscopic Lumbar Decompression and Fusion: A Retrospective Observational Study.
Kim TS, You KH, Jeong SY, Cha SH, Park SM, Park MS, Kim YW, Park HJ
Topics
Key Takeaway
Sarcopenia did not worsen 12-month ODI or complication rates after biportal endoscopic lumbar surgery, but sarcopenic fusion patients had a 3.1-day longer hospital stay (15.0 vs. 11.9 days, P=0.003).
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Summary
This study examined whether sarcopenia — defined by ASM, handgrip strength, and 6-m gait speed — adversely affects outcomes after biportal endoscopic lumbar decompression or fusion. ODI and EQ-5D improved in all groups with no significant between-group difference at 12 months, and complication rates were equivalent. Sarcopenic fusion patients had a significantly longer hospital stay (15.0 vs. 11.9 days, P=0.003) with a trend toward higher postoperative CRP and CPK, suggesting delayed early recovery without long-term functional penalty.
Key Limitation
The fusion cohort (n=52) is underpowered to detect differences in complication rates or MCID-level PROM gaps between sarcopenic and non-sarcopenic patients, risking a type II error for clinically important outcomes.
Original Abstract
STUDY DESIGN
Retrospective, single-center study.
OBJECTIVE
To evaluate the effects of sarcopenia on perioperative parameters and postoperative outcomes in patients undergoing biportal endoscopic lumbar surgery.
SUMMARY OF BACKGROUND DATA
Sarcopenia is associated with adverse surgical outcomes. However, its impact on minimally invasive procedures, particularly biportal endoscopic lumbar surgery, remains unclear.
METHODS
We retrospectively analyzed data from 153 patients who underwent biportal endoscopic lumbar surgery (decompression, n=101; fusion, n=52) between October 2021 and November 2023. Patients were classified into sarcopenia and non-sarcopenia groups based on appendicular skeletal muscle mass (ASM), handgrip strength, and 6-m gait speed. Demographic characteristics, perioperative parameters, clinical outcomes, and complication rates were compared between the groups. Outcomes were assessed from the preoperative period to 12 months postoperatively.
RESULTS
ASM and 6-m gait speed were significantly lower in patients with sarcopenia, within both decompression and fusion cohorts (P<0.001). The Oswestry Disability Index and EuroQol-5D index improved in all groups, without significant between-group differences at 12 months postoperatively. In the fusion group, patients with sarcopenia had a significantly longer hospital stay (15.0 vs. 11.9 d, P=0.003), despite similar operative time and estimated blood loss. Postoperative C-reactive protein and creatine phosphokinase levels were higher in patients with sarcopenia undergoing fusion, without reaching significance. Complication rates were equivalent in all groups.
CONCLUSIONS
Sarcopenia was not associated with inferior clinical outcomes or higher complication rates following biportal endoscopic lumbar surgery. However, patients with sarcopenia undergoing fusion surgery experienced a longer hospital stay, suggesting delayed early postoperative recovery. Overall, biportal endoscopic lumbar surgery may be an acceptable surgical option for patients with sarcopenia.