The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature

Moskven, Eryck; Bourassa-Moreau, Étienne; Charest-Morin, Raphaële; Flexman, Alana M.; Street, John

doi:10.1016/j.spinee.2018.07.008

Cited by 88 publications

(99 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…41 A recent systematic review of the literature found that despite discrepancies in measurement tools, frailty is a consistent predictor of mortality, minor and major morbidity, in-hospital LOS, and discharge disposition in patients undergoing spine surgery. 42 Traditionally, however, frailty is a concept that has been intimately linked with older age. 43 Bagshaw and associates were among the first groups to note that the prevalence of frailty in younger…”

Section: Discussionmentioning

confidence: 99%

“…Multiple measures of frailty are used in research and published in the literature, and simplified measures such as the mFI and Charlson and Elixhauser comorbidity indexes are not nuanced enough to capture important physiological changes that underpin the multi-dimensional concept of frailty, such as nutritional status, cognitive impairment, and poor performance status. 42 Additionally, cutoff frailty values as used in this and other studies may not apply to tSCI. The insult of the tSCI itself may be so great that it may affect outcomes to a higher degree than values currently used.…”

Section: Frailty In Traumatic Sci 843mentioning

confidence: 99%

See 1 more Smart Citation

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

Self Cite

View full text Add to dashboard Cite

Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Frailty In Traumatic Sci 843mentioning

confidence: 99%

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

Self Cite

View full text Add to dashboard Cite

show abstract

“…Secondly, though this propensity score matched cohort analysis minimized the heterogeneity of ASD, some potential risk factors for PJK or PJF were not commonly assessed, such as prevalence of sarcopenia in middle-aged and elderly women 24 and disruption of the posterior osseo-ligamentous complex.…”

Section: Discussionmentioning

confidence: 99%

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF  in Patients With Osteoporosis: A Propensity Score–matched Analysis

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: To elucidate the role of prophylactic vertebroplasty (PV) at UIV+1 and cement-augmented fenestrated pedicle screw (CAFPS) in prevention of PJK and PJF.Background: Cement augmentation at UIV and UIV+1 was found to prevent PJK and PJF. But most studies are retrospective and have a selection bias due to multifactorial etiology of PJF, making it difficult to identify the efficacy of prophylactic cement augmentation. Methods: We enrolled 208 surgically treated adult spinal deformity (ASD) patients who were followed for at least 2 years, to elucidate whether prophylactic cement augmentation was truly minimizing the risk of PJK and PJF in a uniform population from one center database. Patients were classified into two groups. Two comparable groups were propensity-matched with one to one nearest neighbor matching. The main outcome variables including PJK, PJF, pedicle screw loosening and cement leakage were compared.Results：After propensity score matching, there were 58 propensity-matched patients in group A and B (n=29 in each group) whose parameters including age, BMI, BMD, number of instrumented vertebrae, SVA, spinal-pelvic parameters and the frequency of UIV and LIV were similar. The incidence of PJK showed no significantly statistical difference between group A and B (10.3% vs 13.8%, p >0.99). Compared to group A, group B had a higher proportion of patients developing PJF (24.1% vs 0%, p=0.01). Pedicle screw loosening at UIV and (or) LIV showed no difference (24.1% vs 3.4%, p=0.052) between two groups. In group A, cement leakage was detected in 5 cases via fluoroscopy, but none of them had neurological deficit or pulmonary cement embolism.Conclusion: Combined application of CAFPS and PV could reduce the incidence of PJF, but it could not prevent the development of PJK in the surgical management of ASD with low BMD or osteoporosis.

show abstract

“…In addition to the effect of spinal sarcopenia on lumbar surgery outcomes, several studies have evaluated the effects of spinal sarcopenia on the sagittal alignment of the cervical spine after cervical laminoplasty [99,100]. The results revealed that, compared with patients without sarcopenia, the C2-C7 SVA was greater and the postoperative outcome was worse after cervical laminoplasty in patients with sarcopenia.…”

Section: Impact Of Spinal Sarcopenia On Surgical Interventions For Spmentioning

confidence: 99%

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Kuo

Lin

Lee

et al. 2020

IJMS

View full text Add to dashboard Cite

Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems—such as osteoporotic fractures and low bone mineral density—and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.

show abstract

The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature

Cited by 88 publications

References 31 publications

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF  in Patients With Osteoporosis: A Propensity Score–matched Analysis

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Contact Info

Product

Resources

About

The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature

Cited by 88 publications

References 31 publications

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF&nbsp; in Patients With Osteoporosis: A Propensity Score–matched Analysis

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Contact Info

Product

Resources

About

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF in Patients With Osteoporosis: A Propensity Score–matched Analysis