Muscle Health in Spine Surgery: From Risk Stratification and Surgical Optimization to Functional Recovery

Dear Colleagues,

Muscle health is increasingly recognized as an important determinant of clinical outcomes in patients undergoing spine surgery. Sarcopenia, frailty, and degeneration of the paraspinal musculature may influence preoperative spinal alignment, surgical risk, postoperative complications, and functional recovery.

Systemic sarcopenia and spine-specific paraspinal muscle degeneration represent related but distinct aspects of muscle health. Reduced muscle mass, poor muscle quality, and fatty infiltration may be associated with sagittal and coronal malalignment before surgery and may also influence the maintenance of postoperative correction, mechanical complications, and long-term functional outcomes.

Importantly, surgical techniques themselves may also affect muscle health. Differences in surgical approach, the extent of muscle dissection and retraction, and the use of open versus minimally invasive or muscle-preserving techniques may result in varying degrees of paraspinal muscle injury, denervation, atrophy, and fatty degeneration. These postoperative muscle changes may, in turn, contribute to differences in spinal stability, alignment, pain, physical function, and recovery. Understanding these interactions may help optimize surgical strategies while minimizing procedure-related muscle damage.

Advances in CT- and MRI-based muscle assessment, automated segmentation, artificial intelligence, and functional evaluation provide new opportunities to quantify these changes and clarify their clinical significance.

This Special Issue aims to highlight recent advances in muscle health across the continuum of spine surgery, including preoperative risk stratification, the relationship between muscle status and spinal alignment, surgery-related muscle injury, surgical optimization, postoperative alignment, and functional recovery. We welcome studies addressing sarcopenia, paraspinal muscle degeneration, surgical approaches, muscle-preserving techniques, spinal alignment, postoperative complications, rehabilitation, and patient-reported outcomes.

Ultimately, this Special Issue seeks to support more personalized and muscle-conscious strategies for improving surgical and functional outcomes in spine care.

Topics of interest

• Sarcopenia and paraspinal muscle degeneration in spine surgery;
• Muscle health and preoperative sagittal and coronal spinal alignment;
• Impact of muscle health on postoperative alignment and correction maintenance;
• Paraspinal muscle quality and mechanical complications after spine surgery;
• Surgical approach-related paraspinal muscle injury and functional outcomes;
• Open versus minimally invasive and muscle-preserving spine surgery;
• Sarcopenia, frailty, and perioperative risk stratification;
• Imaging and artificial intelligence for quantitative assessment of spinal muscle health;
• Prehabilitation, postoperative rehabilitation, and functional recovery.

Prof. Dr. Kyung-Chung Kang
Dr. Yong-Gon Seo
Guest Editors

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