The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis

Saiki Sugimoto; Sota Nagai; Kei Ito; Hiroki Takeda; Soya Kawabata; Takehiro Michikawa; Daiki Ikeda; Shinjiro Kaneko; Nobuyuki Fujita

doi:10.22603/ssrr.2023-0171

The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis

Spine Surg Relat Res. 2023 Nov 2;8(2):188-194. doi: 10.22603/ssrr.2023-0171. eCollection 2024 Mar 27.

Authors

Saiki Sugimoto¹, Sota Nagai¹, Kei Ito¹, Hiroki Takeda², Soya Kawabata¹, Takehiro Michikawa³, Daiki Ikeda¹, Shinjiro Kaneko², Nobuyuki Fujita¹

Affiliations

¹ Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.
² Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan.
³ Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.

Abstract

Introduction: Frailty is an important factor in surgical outcomes. The current study aimed to evaluate the effect of preoperative frailty on postoperative outcomes in older patients with lumbar spinal canal stenosis (LSCS).

Methods: We retrospectively examined 209 patients aged ≥65 years who underwent surgery for LSCS. Health-related quality-of-life (HRQOL) tools, including the Roland-Morris Disability Questionnaire (RDQ), Zurich Claudication Questionnaire (ZCQ), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), were used in the assessment conducted before surgery and at 6 months and 1 year after surgery. Frailty was categorized based on the 11-item modified frailty index (mFI-11). Patients with mFI-11 of 0, <0.21, and >0.21 were classified under the robust (R), pre-frailty (P), and frailty (F) groups, respectively.

Results: According to the mFI-11, 24, 138, and 47 patients were included in the R, P, and F groups, respectively. Regarding preoperative radiographic parameters, there was a remarkable increase in the sagittal vertical axis and a significant decrease in the development of lumbar lordosis with frailty progression. The preoperative scores of RDQ and ZCQ, and lumbar function, walking ability, social life, and psychological disorder domain scores of JOABPEQ differed significantly among these groups. The frequency of revision surgery was not higher in the F group than in the other groups. After adjustment for factors have shown different distributions among the three groups, the frequency of effective surgical cases did not show a clear trend among the three groups in all domains of the JOABPEQ.

Conclusions: The preoperative HRQOL scores and the radiographic parameters of patients with LSCS worsened with frailty severity. However, frailty did not affect the rate of revision surgery and surgical efficacy in patients with LSCS. Although this study has limitations, our findings indicated that even LSCS patients with frailty can be considered for surgery if they have an indication for LSCS surgery.

Keywords: Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; frailty; lumbar spinal canal stenosis; modified frailty index; surgical outcome.