The Impact of Sarcopenia and Frailty on Motor Recovery and Functional Outcomes in Patients with Acute Traumatic Central Cord Syndrome

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To assess the impact of frailty, using modified 5-item frailty index (mFI-5), and sarcopenia, using temporalis muscle thickness (TMT), on motor and functional outcomes in patients with acute traumatic central cord syndrome (ATCCS). SUMMARY OF BACKGROUND DATA: Patients who suffer from ATCCS often are elderly patients who may be frail and sarcopenic. It would be useful to know the impact it has on their outcome, to see how they fair and identify the areas that need improvement. METHODS: Receiver operating characteristic analysis determined the optimal cut-off value of TMT at 3.965 mm. Patients were considered sarcopenic if their average TMT value was less than 3.965 mm. Primary outcomes were significant improvement in the American Spinal Injury Association Motor Score (AMS) scores at 6 and 12 months. Secondary outcomes were significant improvement in Functional Independence Measure (FIM) at 6 months, and significant recovery of Modified Japanese Orthopedic Association (mJOA) at 6 months. Logistic regression was performed to assess the influence of mFI-5 and TMT on these outcomes. RESULTS: A total of 80 patients were used in this study. Significant improvement in AMS improvement (71.4% vs. 90.4%, P=0.028), significant improvement in FIM (42.9% vs. 71.2%, P=0.013), and significant recovery in mJOA (14% vs. 38%, P=0.039) were all significantly lower in sarcopenic patients. Multivariate analysis found that the presence of sarcopenia was inversely related to significant improvement in FIM at 6 months (OR 0.026, 95% CI 0.002-0.414, P=0.010). The MFI score of 0 was positively associated with significant improvement in FIM at 6 months (OR 64.189, 95% CI 2.643-1412.016, P=0.010). CONCLUSIONS: Frailty and sarcopenia have a significant effect on motor and functional outcomes in ATCCS patients.