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



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.


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.


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.


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.


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.





Published Version (Please cite this version)


Publication Info

Segreto, Frank A, Peter Gust Passias, Avery E Brown, Samantha R Horn, Cole A Bortz, Katherine E Pierce, Haddy Alas, Virginie Lafage, et al. (2020). The Influence of Surgical Intervention and Sagittal Alignment on Frailty in Adult Cervical Deformity. Operative neurosurgery (Hagerstown, Md.), 18(6). pp. 583–589. 10.1093/ons/opz331 Retrieved from

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Peter Passias

Instructor in the Department of Orthopaedic Surgery

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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