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. 2025 Apr-Jun;16(2):148-156.
doi: 10.4103/jcvjs.jcvjs_204_24. Epub 2025 Jul 3.

Frailty index as predictors of loss of cervical lordosis following laminoplasty in patients with cervical spondylotic myelopathy

Michael Ryan Kann  1 , Miguel A Ruiz-Cardozo  2 , Karma Barot  2 , Karan Joseph  2 , Tim Bui  2 , Salim Yakdan  2 , Samuel Brehm  2 , Gabriel Trevino  2 , Abigail Carey-Ewend  2 , Michael Olufawo  2 , Alexander Thomas Yahanda  2 , Brenton Pennicooke  2 , Camilo A Molina  2
Affiliations

Frailty index as predictors of loss of cervical lordosis following laminoplasty in patients with cervical spondylotic myelopathy

Michael Ryan Kann et al. J Craniovertebr Junction Spine. 2025 Apr-Jun.

Abstract

Background: Postlaminoplasty kyphotic deformity (PKD) is a complication affecting roughly 20% of patients undergoing cervical laminoplasty. Identification of preoperative risk factors for PKD could allow surgeons to adapt treatment plans to reduce PKD.

Objective: The aim of this study was to investigate the ability of the Charlson Comorbidity Index (CCI), 5-item Modified Frailty Index (5i-mFi), and Administrative Risk Analysis Index (RAI-A) to predict for the development of PKD in patients with cervical spondylotic myelopathy (CSM) undergoing laminoplasty.

Materials and methods: We retrospectively reviewed CSM patients who underwent laminoplasty at an academic tertiary care center between January 1, 2016, and January 30, 2022, and had a complete set of anterolateral cervical X-rays at 1-year follow-up. Angular kyphosis was defined as the loss of cervical lordosis by more than - 10° after surgery when measuring the difference between pre- and post-operative C2-7 Cobb angles. Regression and receiver operating characteristic (ROC) curve analysis were used to assess the ability of the frailty assessments to predict for PKD.

Results: Seventy-six CMS patients were eligible, 11.8% of which developed PKD. The cohort consisted of 54 males and 22 females with a mean age of 59.5 years and body mass index of 29.2 kg/m2. No CCI, 59-mFi, or RAI-A frailty subgroup was associated with kyphotic development and ROC curve analysis showed that neither CCI (P = 0.81), 5i-mFi (P = 0.59), nor RAI-A (P = 0.63) predicted for PKD. None of these assessments were a superior prognosticator of PKD.

Conclusion: CCI, 5i-mFi, and RAI-A frailty assessments were not associated with the development of PKD in CSM patients.

Keywords: Cervical laminoplasty; cervical myelopathy; frailty; postoperative kyphosis.

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Conflict of interest statement

Dr. Camilo Molina is a consultant for Augmedics, Stryker, DePuy Synthes, Kuros Biosciences.

Figures

Figure 1
Figure 1
Radiographic assessment of the cervical spine in patients with cervical spondylotic myelopathy. (Left) Preoperative X-rays in a 60-year old male (Right) Postoperative X-rays in a 60-year old male demonstrating kyphotic changes based on the C2-7 Cobb angle
Figure 2
Figure 2
Receiver operating characteristic/area under the curve analysis for the relative predictive abilities of the (Red) Charlson Comorbidity Index, (Blue) 5-item Modified Frailty Index, and (Green) Administrative Risk Analysis Index on postlaminoplasty kyphotic deformity
See this image and copyright information in PMC

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