# The impact of preoperative handgrip strength on postoperative outcomes following transforaminal lumbar interbody fusion

## TL;DR

Low handgrip strength before surgery is linked to worse recovery outcomes after lumbar spine surgery, suggesting it could help identify patients at risk.

## Contribution

This study is the first to demonstrate that preoperative handgrip strength correlates with postoperative recovery following TLIF surgery.

## Key findings

- Lower preoperative handgrip strength was associated with significantly poorer functional outcomes up to 12 months post-surgery.
- A one-unit decrease in handgrip strength correlated with reduced scores in JOA, EQ-5D-3L, and Barthel Index.
- Male sex, higher BMI, and lower comorbidity index were linked to better postoperative outcomes.

## Abstract

With an aging population, the prevalence of lumbar spinal diseases necessitating surgical intervention is increasing. Handgrip strength (HGS) has emerged as a simple measure of muscle function that may correlate with surgical outcomes. However, the role of HGS concerning postoperative recovery following transforaminal lumbar interbody fusion (TLIF) is not well-studied, highlighting a gap in the literature regarding its potential as a prognostic tool.

This prospective observational study included 89 patients who underwent TLIF performed by a single surgeon. Patients were categorized into normal and low HGS groups based on preoperative HGS measurements. Demographics, baseline HGS, and surgical details were recorded, and outcomes were assessed using the JOA, EQ-5D-3L, and Barthel Index at 3, 6, and 12 months postoperatively. Generalized Estimating Equations were used to examine associations between baseline parameters and outcomes over time.

All patients were followed for at least one year, except for 15 (15.6%) who were lost to follow-up before the one-year mark. Patients with lower preoperative HGS were associated with significantly poorer postoperative functional outcomes. Specifically, a one-unit decrease in HGS was associated with a 2.551-point decrease in the JOA score (p = 0.008), a 0.142-point decrease in the EQ-5D-3L score (p = 0.007), and a 5.784-point decrease in the Barthel Index (p = 0.036). Additionally, male sex, higher body mass index, and lower Charlson comorbidity index were associated with better postoperative outcomes.

Low preoperative handgrip strength is associated with poorer functional, quality of life, and independence outcomes up to 12 months after TLIF surgery. Assessing HGS preoperatively may provide clinicians with valuable information for identifying patients at risk of suboptimal recovery. Future research could explore intervention strategies to improve preoperative muscle function and potentially enhance recovery outcomes for patients undergoing TLIF.

The online version contains supplementary material available at 10.1186/s13018-025-05717-z.