Aug 2026· International Journal of Science and Research (IJSR)· pp. 40-46· 0 citations· 32 references
TL;DR
An Aging Spine Surgical Host framework is proposed that integrates frailty, sarcopenia, osteoporosis, nutrition, cognition, mobility, and surgical magnitude into four actionable grades: robust, vulnerable, high-risk, and prohibitive or modifiable high-risk.
Abstract
: Older adults are increasingly offered decompression, fusion, deformity correction, and vertebral fracture procedures, yet chronological age alone is an inadequate measure of operative risk. Frailty, sarcopenia, and osteoporosis represent overlapping but distinct domains of diminished physiologic reserve, impaired muscle function, and compromised bone strength. Each domain is common in spine-surgery candidates and has been associated with adverse perioperative events, prolonged hospitalization, non-home discharge, delayed functional recovery, mechanical complications, and revision surgery. This narrative review summarizes contemporary evidence on frailty, sarcopenia, and osteoporosis in adult spine surgery and proposes a practical perioperative risk-stratification framework for clinical use. Frailty should be considered a multidimensional vulnerability state rather than a synonym for advanced age. Sarcopenia should be screened with functional tools and confirmed with muscle quantity or quality assessment when possible, with attention to Asian diagnostic criteria. Osteoporosis and osteopenia require active preoperative detection because poor bone health increases the risk of screw loosening, cage subsidence, pseudarthrosis, proximal junctional failure, adjacent fracture, and reoperation. Current evidence supports routine screening in at-risk patients, optimization of nutrition and physical function, correction of vitamin D deficiency, and consideration of bone-active therapy before major reconstructive procedures. We propose an Aging Spine Surgical Host framework that integrates frailty, sarcopenia, osteoporosis, nutrition, cognition, mobility, and surgical magnitude into four actionable grades: robust, vulnerable, high-risk, and prohibitive or modifiable high-risk. This framework is intended to improve shared decision-making, trigger prehabilitation and bone-health optimization, and help surgeons select the least morbid durable procedure. Prospective validation is required before formal prognostic use.
Thoracolumbar trauma in elderly patients has become increasingly important as population aging has reshaped the epidemiology of spinal injury. In the aging spine, low-energy trauma can produce clinically significant or unstable fractures because osteoporosis, degenerative stiffness, and rigid spine disorders alter mechanical behavior. Conventional classification systems and guideline-based algorithms remain useful for describing fracture morphology, neurological status, and structural instability. However, their applicability in elderly patients is limited because treatment decisions must account for frailty-related vulnerability and the functional consequences of immobilization. This review summarizes the distinctive features of thoracolumbar trauma in the aging spine and proposes an integrated framework that combines structural injury severity with frailty-based assessment of treatment tolerance. Frailty reduces physiologic reserve and limits the ability to tolerate treatment and recover after injury, while poor bone quality and spinal rigidity increase the risk of structural failure even with guideline-concordant care. Treatment should aim to restore stability, preserve neurological function, control pain, and enable early mobilization while minimizing physiologic burden. Depending on structural demand, treatment may range from non-operative care or vertebral augmentation in appropriate patients to definitive fixation, with selection guided by bone quality, frailty, and expected functional benefit. Thoracolumbar trauma in the aging spine should be managed as a distinct clinical entity for which an integrated frailty-based framework may better support practical, patient-centered decision-making.
Seung-Hoon Lee, Matthew W. Scarsbrook, Joonho Byun et al.· Journal of Korean Neurosurgi...· 0 citations
Vertebral compression fractures (VCFs) represent the most prevalent osteoporotic fracture and constitute a growing cause of morbidity, mortality, and healthcare utilization worldwide. Although often considered benign, VCFs are associated with chronic pain, progressive spinal deformity, functional impairment, decreased pulmonary capacity, and increased short- and long-term mortality, especially in older adults. Despite their high prevalence, key challenges persist regarding appropriate diagnostic evaluation, optimal treatment selection, and integration of osteoporosis management following fracture. This narrative review consolidates current evidence on the epidemiology, pathophysiology, diagnostic evaluation, management strategies, and public health implications of VCFs, with a focus on emerging spine-focused care models. VCFs predominantly result from compromised vertebral strength secondary to osteoporosis-related deterioration of trabecular microarchitecture, although traumatic and pathologic etiologies should also be considered. Diagnosis involves careful clinical assessment combined with imaging, with magnetic resonance imaging serving as a key modality for distinguishing acute fractures from chronic deformities or malignancy. Despite advances in diagnostic techniques, VCFs remain underrecognized and undertreated, contributing to avoidable disability and recurrent fractures. This narrative review synthesizes contemporary evidence, highlighting practical considerations for clinical decisionmaking in VCF care. Particular emphasis is placed on differentiating acute symptomatic fractures from chronic deformities or pathologic collapse, identifying patients most likely to benefit from vertebral augmentation, and defining surgical indications in the setting of neurologic compromise, instability, or progressive deformity. Conservative management, incorporating analgesia, early mobilization, and rehabilitation, remains the first-line approach for most stable fractures. Vertebroplasty and balloon kyphoplasty may provide short-term pain relief in carefully selected patients with persistent symptoms. However, the long-term benefits of augmentation and optimal patient selection criteria remain under investigation. Treatment options range from conservative measures—including analgesia, bracing, mobilization, rehabilitation, and osteoporosis-directed pharmacotherapy—to minimally invasive vertebral augmentation procedures such as vertebroplasty and balloon kyphoplasty. Vertebral augmentation may provide short-term improvements in pain and function in appropriately selected patients, although its long-term benefits and optimal indications remain under investigation. Surgical decompression and stabilization are reserved for patients with neurological compromise, instability, or progressive deformity. From a public health perspective, deficiencies in osteoporosis screening, delayed diagnosis, and disparities in treatment access continue to affect diverse socioeconomic and racial groups. Emerging innovations, including fracture liaison services, risk stratification tools such as FRAX, and artificial intelligence–based predictive models, may enhance early detection and personalized care. VCFs represent sentinel manifestations of systemic skeletal fragility that warrant evaluation of underlying osteoporosis and implementation of secondary fracture prevention. Pharmacologic therapies, including antiresorptive and anabolic agents, play a key role in reducing recurrent fracture risk, although treatment selection should be individualized. Multidisciplinary, patient-centered strategies focused on early diagnosis, prevention, equitable care delivery, and standardized management are essential to address the growing global burden of VCFs. A structured, patient-centered approach to diagnosis, treatment selection, and post-fracture care may enhance outcomes and reduce the long-term burden associated with VCFs.
G. Findlay, Mark Ehioghae, Lancelot Benn et al.· Asian Spine Journal· 0 citations
BACKGROUND
Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk.
METHODS AND MAIN FINDINGS
This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature.
CONCLUSIONS
Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery.
Yiming Xu, Mingming Cao, Yuting Liu et al.· World Journal of Surgical On...· 0 citations
Study Design Retrospective cohort study. Purpose To compare three cervical sarcopenia metrics and frailty as preoperative predictors of unfavorable postoperative outcomes following surgical fixation of odontoid fractures. Overview of Literature Sarcopenia is increasingly recognized as an indicator of physiologic vulnerability in spine surgery and thoracolumbar trauma. However, its prognostic significance in odontoid fractures remains unclear, and no previous study has directly compared cervical sarcopenia measurement sites in this population. Methods Adult patients who underwent surgical fixation of traumatic odontoid fractures at a single level I trauma center were retrospectively reviewed. Sarcopenia was quantified on perioperative computed tomography using sternocleidomastoid, prevertebral, and paraspinal cross-sectional area normalized to the C3 vertebral body area. Frailty was assessed using the 5-factor modified frailty index (mFI-5), with hypertension status confirmed through a review of prescribed medications. Associations with postoperative outcomes were evaluated using threshold-based analyses, intercorrelation testing, subgroup analysis of combined low-sarcopenia/high-frailty patients, and an exploratory Combined Sarcopenia-Frailty Score. Results This study included 61 patients (mean age, 61.7 years; 50.8% female). The three sarcopenia metrics were only modestly intercorrelated (Spearman rho, 0.34–0.47), with 46.7%–53.3% overlap among patients in the most sarcopenic quartiles. No individual sarcopenia or mFI-5 threshold independently predicted postoperative outcomes. However, patients in the most sarcopenic quartile on any cervical metric with an mFI-5 ≥2 (n=11) experienced higher rates of mortality, urinary tract infection, pneumonia, and nonunion. In exploratory receiver operating characteristic analysis, the Combined Sarcopenia-Frailty Score exhibited moderate discrimination for significant adverse events, with an area under the curve of 0.73 and an optimal threshold of ≥9. Conclusions Cervical sarcopenia and frailty were not independently associated with adverse outcomes following odontoid fracture fixation. However, their combination identified patients at substantially higher risk for mortality, complications, and nonunion, supporting a potential role for combined preoperative risk stratification (Level of Evidence: level III).
Sapan Patel, Hershil Patel, R. Suresh et al.· Asian Spine Journal· 0 citations
Background: Frailty reflects diminished physiological reserve and may influence postoperative recovery after proximal femur fracture surgery in older adults. This study evaluated clinical frailty as a predictor of early functional recovery and postoperative complications.
Methods: This prospective observational study included 69 patients aged ≥60 years undergoing surgery for proximal femur fractures in the Department of Emergency Medicine, Kanachur Institute of Medical Sciences, Mangalore, from January to December 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), with CFS ≥5 defining frailty. Early ambulation, Parker Mobility Score, hospital stay, and postoperative complications were evaluated.
Results: Twenty-nine patients (42.0%) were frail. Frail patients required significantly longer to achieve first ambulation than non-frail patients (4.4±1.8 vs 2.5±1.1 days; p<0.001). Ambulation by postoperative day three was achieved in 34.5% of frail versus 77.5% of non-frail patients. Postoperative complications occurred in 51.7% and 20.0%, respectively (p=0.006). Frailty independently predicted delayed functional recovery (adjusted OR 4.82; 95% CI 1.66–14.02) and postoperative complications (adjusted OR 3.26; 95% CI 1.09–9.73).
Conclusion: Preoperative clinical frailty independently predicted slower functional recovery and greater postoperative morbidity following proximal femur fracture surgery.
Kora Sai Sujith, Penchala Pradeep Batta· Journal of Medicine Pharmaco...· 0 citations
Modern orthogeriatric care, based on multidisciplinary collaboration, timely surgical management, individualized rehabilitation, nutritional optimization, osteoporosis treatment, and secondary fracture prevention, consistently improves mobility, functional independence, postoperative outcomes, and long-term quality of life.
Nilmar Del Valle Toro Arvelaiz, Diana Beatríz Alvarado Ochoa, Fabián Patricio Miranda Yáñez et al.· International science journa...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
