2Hacettepe University Faculty of Medicine, Dept of Physical Medicine and Rehabilitation (retired), Ankara, Türkiye DOI : 10.29400/tjgeri.2025.443 Historically, spinal surgery has prioritized bone integrity, often overlooking the biomechanical significance of the paraspinal muscles. Sarcopenia, an agerelated decline in muscle mass, strength, and function, has emerged as a critical modifier of spinal pathology and surgical outcomes. Sarcopenia is characterized by progressive myosteatosis, particularly in the multifidus and erector spinae, which contributes to spinal imbalance, chronic pain, and functional decline. Fatty infiltration, a key marker of muscle degeneration, is strongly associated with frailty, reduced mobility, and impaired quality of life.
Spinal musculature plays an essential role in maintaining posture, segmental control, and load-bearing capacity. Muscle deterioration exacerbates spinal deformities and degrades surgical outcomes, particularly during procedures involving extensive dissection or fusion. Even minimally invasive techniques may result in scarring and atrophy, increasing the risk of complications, such as nonunion, adjacent segment disease, or implant failure.
As spinal sarcopenia becomes increasingly prevalent in aging populations, surgical strategies must evolve accordingly. Minimally invasive motionpreserving approaches, along with targeted rehabilitation, are essential for preserving muscle function. Radiological assessments should routinely include muscle density and bone metrics, and sarcopenia should be integrated into surgical planning as well as risk stratification.
Recognizing the spinal musculature as a dynamic, modifiable structure? rather than a passive one?is imperative. Addressing sarcopenia through a comprehensive preoperative evaluation, intraoperative techniques, and postoperative rehabilitation may significantly enhance patient outcomes and long-term spinal health.
Keywords : Spine; Aging; Sarcopenia