Spine Fellow University of California, San Francisco San Francisco, California, United States
Introduction: The modified Frailty Index (mFI) is an assessment tool used in the preoperative setting to determine patient health prior to a surgical procedure. The mFI correlates with poor outcomes after spinal surgery. The objective of this study is to determine if mFI affects cervical lordosis after laminoplasty.
Methods: Patients undergoing posterior cervical laminoplasty for degenerative spinal diseases were retrospectively reviewed at a single institution. Only cervical laminoplasty between C3 to C7 were included. The primary outcome measure, loss of cervical lordosis, equaled preoperative cervical lordosis minus cervical lordosis at 1 year postoperation. All measurements were calculated from standing C-spine x-ray films. The 11-point mFI was measured as a surrogate marker of patients’ health condition. Per previous publications, frailty was defined as a mFI≥0.27. A multivariable linear regression analysis predicting loss of cervical lordosis was generated with clinical relevant and statistically significant variables in the simple linear regression.
Results: Of the 100 patients, laminoplasty cohort had a mean age of 63.6yr and BMI of 28.48. Females reached 36%. Frail patient composed 14%. Mean preoperative cervical lordosis of 12.3° decreased to 10.1° postoperatively (mean difference=-2.25°, p=0.024). Loss of cervical lordosis did not differ with frail patients (p=0.512). Four patients experienced 90-day readmission postoperatively (3.5% non-frail vs 7.1% frail, p=0.518), and one non-frail patient underwent reoperation for postoperative cervical kyphosis within 1 year of surgery. In a linear regression controlling for age, preoperative cervical lordosis, and sex, mFI failed to predict loss of cervical lordosis (p=0.295). Preoperative cervical lordosis was the only significant predictor of the outcome measure (p < 0.001).
Conclusion : For patients with mFI scores of mean 0.10 and range 0-0.64, frailty does not impact loss of cervical lordosis, 90-day readmission, or 1-year reoperation rates following a laminoplasty procedure. Laminoplasty is a safe procedure that may be considered in patients with a less-than-optimal physical condition.
