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

Mark A MacLean; Antoinette J Charles; Miltiadis Georgiopoulos; Jackie Phinney; Raphaële Charest-Morin; Rory Goodwin; Ilya Laufer; Michael G Fehlings; John Shin; Nicholas Dea; Laurence D Rhines; Arjun Sahgal; Ziya Gokaslan; Byron Stephens; Alexander C Disch; Naresh Kumar; John O'Toole; Daniel M Sciubba; Cordula Netzer; Tony Goldschlager; Wende Gibbs; Michael H Weber; AO Spine Knowledge Forum Tumor

doi:10.1177/21925682231207325

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

Global Spine J. 2025 Jan;15(1_suppl):47S-80S. doi: 10.1177/21925682231207325.

Authors

Mark A MacLean¹, Antoinette J Charles², Miltiadis Georgiopoulos³, Jackie Phinney⁴, Raphaële Charest-Morin⁵, Rory Goodwin², Ilya Laufer⁶, Michael G Fehlings⁷, John Shin⁸, Nicholas Dea⁵, Laurence D Rhines⁹, Arjun Sahgal¹⁰, Ziya Gokaslan¹¹, Byron Stephens¹², Alexander C Disch¹³, Naresh Kumar¹⁴, John O'Toole¹⁵, Daniel M Sciubba¹⁶, Cordula Netzer¹⁷, Tony Goldschlager¹⁸, Wende Gibbs¹⁹, Michael H Weber³; AO Spine Knowledge Forum Tumor

Affiliations

¹ Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
² Spine Division, Department of Neurosurgery, Duke University, Durham, NC, USA.
³ Spine Surgery Program, Department of Surgery, McGill University, Montreal, QC, Canada.
⁴ W.K Kellogg Health Sciences Library, Saint John, NB, Canada.
⁵ Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
⁶ Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
⁷ Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.
⁸ Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
⁹ Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA.
¹⁰ Sunnybrook Health Sciences Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹² Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
¹³ University Center for Orthopedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany.
¹⁴ Department of Orthopedic Surgery, National University Health System, Singapore.
¹⁵ Department of Neurosurgery, Rush University, Chicago, IL, USA.
¹⁶ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
¹⁷ Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland.
¹⁸ Department of Surgery, Monash University, Melbourne, VIC, Australia.
¹⁹ Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ, USA.

PMID: 39801122
DOI: 10.1177/21925682231207325

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^st, 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/Height², and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height²). 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.

Keywords: disease; frailty; metastatic; sarcopenia; spine; tumor.