title: Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression.
abstract: BACKGROUND
  Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival.
  
  
  METHODS
  Muscle mass was calculated as total psoas area (TPA)/ vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases surgery, at the mid L3 vertebral level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database.
  
  
  RESULTS
  86 patients were followed for 1 year, with an overall mortality of 39.5%. Mortality rates at 1 year were significantly high among patients in the lowest quartile of muscle mass, compared with those in the highest quartile (57.1 vs 23.8%, p=0.02).
  
  
  CONCLUSIONS
  Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK. gul34@yahoo.com.
authors.forename: H
authors.initials: H
authors.lastname: Gakhar
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dhillon
authors.affiliation: Anaesthetic Department, Division Surgery, Royal Derby Hospital, Derby, DE223NE, UK.
authors.forename: J
authors.initials: J
authors.lastname: Blackwell
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hussain
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bommireddy
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK.|3rd Medical School, Charles' University Prague, Prague, Czech Republic.
authors.forename: Z
authors.initials: Z
authors.lastname: Klezl
authors.affiliation: Spinal Unit, Division of Surgery, Royal Derby Hospital, Derby, DE223NE, UK. john.williams7@nhs.net.|MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Nottingham, DE22 3DT, UK. john.williams7@nhs.net.|Anaesthetic Department, Division Surgery, Royal Derby Hospital, Derby, DE223NE, UK. john.williams7@nhs.net.|School of Graduate Entry Medicine and Health, Derby City General Hospital, University of Nottingham, Derby, DE22 3DT, UK. john.williams7@nhs.net.
authors.forename: J
authors.initials: J
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D055948:Sarcopenia / Q000150:complications* / Q000000981:diagnostic imaging; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Lean muscle mass; Metastatic spinal cord compression; Sarcopenia