A Critical Appraisal of the Application of Frailty and Sarcopenia in the Spinal Oncology Population

Authors

Mark A. MacLean, Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Antoinette J. Charles, Spine Division, Department of Neurosurgery, Duke University, Durham, NC, USA.
Miltiadis Georgiopoulos, Spine Surgery Program, Department of Surgery, McGill University, Montreal, QC, Canada.
Jackie Phinney, W.K Kellogg Health Sciences Library, Saint John, NB, Canada.
Raphaële Charest-Morin, Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Rory Goodwin, Spine Division, Department of Neurosurgery, Duke University, Durham, NC, USA.
Ilya Laufer, Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
Michael G. Fehlings, Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.
John Shin, Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Nicholas Dea, Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Laurence D. Rhines, Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA.
Arjun Sahgal, Sunnybrook Health Sciences Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Ziya Gokaslan, Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Byron Stephens, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Alexander C. Disch, University Center for Orthopedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany.
Naresh Kumar, Department of Orthopedic Surgery, National University Health System, Singapore.
John O'Toole, Department of Neurosurgery, Rush University, Chicago, IL, USA.
Daniel M. Sciubba, Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
Cordula Netzer, Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland.
Tony Goldschlager, Department of Surgery, Monash University, Melbourne, VIC, Australia.
Wende Gibbs, Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ, USA.
Michael H. Weber, Spine Surgery Program, Department of Surgery, McGill University, Montreal, QC, Canada.

Document Type

Article

Abstract

STUDY DESIGN: Systematic review and clinimetric analysis. OBJECTIVES: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we sought to identify frailty and sarcopenia tools applied in spinal oncology and appraise their clinimetric properties. METHODS: A systematic review was conducted from January 1, 2000, until June 2022. Study characteristics, frailty tools, and measures of sarcopenia were recorded. Component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. RESULTS: Twenty-two studies were included (42 514 patients). Seventeen studies utilized 6 frailty tools; the three most employed were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. Eight studies utilized measures of sarcopenia; the three most common were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height). Frailty and sarcopenia measures lacked or had uncertain content and construct validity. Frailty measures were objective except the Johns-Hopkins Adjusted Clinical Groups. All tools were feasible except the Hospital Frailty Risk Score (HFRS). Positive predictive validity was observed for the HFRS and in select studies employing the mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. CONCLUSIONS: Existing tools for evaluating frailty and sarcopenia among patients undergoing surgery for spinal tumors have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.

Publication Date

1-1-2025

Publication Title

Global spine journal

ISSN

2192-5682

Volume

15

Issue

1_suppl

First Page

47S

Last Page

80S

PubMed ID

39801122

Digital Object Identifier (DOI)

10.1177/21925682231207325

Recommended Citation

MacLean, Mark A.; Charles, Antoinette J.; Georgiopoulos, Miltiadis; Phinney, Jackie; Charest-Morin, Raphaële; Goodwin, Rory; Laufer, Ilya; Fehlings, Michael G.; Shin, John; Dea, Nicholas; Rhines, Laurence D.; Sahgal, Arjun; Gokaslan, Ziya; Stephens, Byron; Disch, Alexander C.; Kumar, Naresh; O'Toole, John; Sciubba, Daniel M.; Netzer, Cordula; Goldschlager, Tony; Gibbs, Wende; and Weber, Michael H., "A Critical Appraisal of the Application of Frailty and Sarcopenia in the Spinal Oncology Population" (2025). Neuroradiology. 118.
https://scholar.barrowneuro.org/neuroradiology/118