The Influence of Surgical Intervention and Sagittal Alignment on Frailty in Adult Cervical Deformity

Frank A. Segreto, Peter Gust Passias, Avery E. Brown, Samantha R. Horn, Cole A. Bortz, Katherine E. Pierce, Haddy Alas, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton G. Line, Bassel G. Diebo, Michael P. Kelly, Gregory M. Mundis, Themistocles S. Protopsaltis, Alex Soroceanu, Han Jo Kim, Eric O. Klineberg, Douglas C. Burton, Robert A. HartFrank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


BACKGROUND: Frailty is a relatively new area of study for patients with cervical deformity (CD). As of yet, little is known of how operative intervention influences frailty status for patients with CD. OBJECTIVE: To investigate drivers of postoperative frailty score and variables within the cervical deformity frailty index (CD-FI) algorithm that have the greatest capacity for change following surgery. METHODS: Descriptive analysis of the cohort were performed, paired t-tests determined significant baseline to 1 yr improvements of factors comprising the CD-FI. Pearson bivariate correlations identified significant associations between postoperative changes in overall CD-FI score and CD-FI score components. Linear regression models determined the effect of successful surgical intervention on change in frailty score. RESULTS: A total of 138 patients were included with baseline frailty scores of 0.44. Following surgery, mean 1-yr frailty score was 0.27. Of the CD-FI variables, 13/40 (32.5%) were able to improve with surgery. Frailty improvement was found to significantly correlate with baseline to 1-yr change in CBV, PI-LL, PT, and SVA C7-S1. HRQL CD-FI components reading, feeling tired, feeling exhausted, and driving were the greatest drivers of change in frailty. Linear regression analysis determined successful surgical intervention and feeling exhausted to be the greatest significant predictors of postoperative change in overall frailty score. CONCLUSION: Complications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion can significantly influence postoperative frailty. This analysis is a step towards a greater understanding of the relationship between disability, frailty, and surgery in CD.

Original languageEnglish (US)
Pages (from-to)583-589
Number of pages7
JournalOperative Neurosurgery
Issue number6
StatePublished - Jun 1 2020


  • Adult cervical deformity
  • Ames modifier
  • Cervical deformity frailty index
  • Frailty
  • Frailty drivers
  • Health-related quality of life
  • Postoperative frailty
  • Sagittal alignment
  • Surgical intervention
  • Surgical outcomes

ASJC Scopus subject areas

  • Medicine(all)


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