预测腰椎融合后相邻节段疾病（ASD）的发展将有助于指导术前和术后治疗，以防止再次手术。我们试图评估肌肉减少症是否可以预测经椎间孔腰椎椎间融合术 (TLIF) 后早期 ASD 的发展。回顾性数据收集了 2013 年至 2023 年接受 TLIF 的 109 名患者。其中包括年龄超过 18 岁、接受择期后正中入路 TLIF 的患者。先前接受过腰椎器械融合、外伤、中枢神经系统感染、癌症或长结构胸腰椎畸形矫正的患者以及缺乏足够随访的患者被排除在外。主要结果是手术后 3 年内放射照相 ASD 的发展。腰肌体积测量是根据最近的术前 MRI 记录的。通过逻辑回归分析计算优势比。在 109 名接受选择性 TLIF 的患者中，22 名 (20.2%) 在 3 年内发展为自闭症谱系障碍 (ASD)。性别、体重指数和手术范围与 ASD 的发展无关。多变量分析显示左/右腰肌横截面积和腰肌:椎体比 (P:VBR) 预测早期 ASD (P < .0001)。肌肉减少症进一步分类为双侧 P:VBR ≥1 SD 低于性别平均值（T 得分 -1）。在 18 名肌肉减少症患者中，有 15 名出现早期 ASD (83.33%)，而 91 名非肌肉减少症患者中则有 7 名 (7.69%；P < .0001)。术后骨盆倾斜度和腰椎前凸之间的不匹配在单变量分析中可预测 ASD (P = .0480)，但在多变量分析中则不然。术后骨盆倾斜和腰椎前凸与早期 ASD 无关。通过腰肌面积减少和 P:VBR 测量的肌肉减少症可预测手术后 3 年内形成 ASD。腰大肌大小的形态测量分析是识别有患 ASD 风险的患者的简单工具。这些信息可能会指导术前和术后治疗，影响手术决策，并有效地为患者提供有关再次手术风险的建议。版权所有 © 神经外科医生大会 2024。保留所有权利。

Predicting the development of adjacent segment disease (ASD) after lumbar spine fusion would help guide preoperative and postoperative therapies to prevent reoperation. We sought to evaluate whether sarcopenia predicts the development of early ASD after transforaminal lumbar interbody fusion (TLIF).Retrospective data were collected from 109 patients who underwent TLIF from 2013 to 2023. Patients older than 18 years who underwent elective posterior midline approach TLIF were included. Patients with prior lumbar instrumented fusions, cases of trauma, central nervous system infection, cancer, or long-construct thoracolumbar deformity corrections and those who lacked sufficient follow-up were excluded. The primary outcome was radiographic ASD development within 3 years of surgery. Psoas volumetric measurements were recorded from the most recent preoperative MRI. Odds ratios were calculated with logistic regression analyses.In 109 patients undergoing elective TLIF, 22 (20.2%) developed ASD within 3 years. Gender, body mass index, and extent of surgery were not associated with ASD development. Multivariate analysis showed left/right psoas cross-sectional area, and psoas:vertebral body ratio (P:VBR) predicted early ASD (P < .0001). Sarcopenia was further categorized as having bilateral P:VBR ≥1 SD below gender mean (T-score -1). Of 18 sarcopenic patients, 15 developed early ASD (83.33%) vs 7 of 91 nonsarcopenic patients (7.69%; P < .0001). Postoperative mismatch between pelvic incidence and lumbar lordosis was predictive of ASD on univariate (P = .0480) but not multivariate analysis. Pelvic tilt and lumbar lordosis postoperatively were not associated with early ASD.Sarcopenia, measured by decreased psoas area and P:VBR, predicts ASD formation within 3 years of surgery. Morphometric analysis of psoas size is a simple tool to identify patients at risk of developing ASD. This information can potentially guide preoperative and postoperative therapies, affect surgical decision making, and effectively counsel patients on risks of reoperation.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.