Patients with a high frailty index have good postoperative outcomes after lateral lumbar interbody fusion, according to a new study.
Good Results With Lateral Lumbar Interbody Fusion in Frail Patients
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The study, “Modified 11-Item Frailty Index and Postoperative Outcomes in Patients Undergoing Lateral Lumbar Interbody Fusion,” was published in the March 2022 issue of SPINE.
In this retrospective study, the researchers sought to examine the relationship between modified 11-item frailty index and lateral lumbar interbody fusion surgery which hasn’t previously been reported.
They particularly looked at postoperative complications and recovery patterns among different frailty index groups.
The 150 patients who underwent lateral lumbar interbody fusion surgery at a single center were grouped by their modified 11-item frailty index score. A score of less than or equal to 0.27 was a predictor of urinary complications (adjusted odds ratio: 3.829; p = 0.013).
All patients had at least two years of follow-up data. The researchers reviewed data on postoperative complications and clinical outcomes.
At year years post-op, patients in frailty categories had improved Visual Analog Scale scores for back and leg pain and improved scores for the Oswestry Disability Index. The researchers reported no significant difference in these scores between the four frailty groups (p = 0.182, 0.121, and 0.804, respectively).
They also found no difference in the proportions of patients achieving substantial clinical benefit for either the Visual Analog Scale or Oswestry Disability Index between the four groups. (p = 0.843, 0.957 and 0.915, respectively).
“A modified 11-item frailty index score was found to be independently associated with urologic complications in patients who underwent lateral lumbar interbody fusion surgery. Patients in all frailty categories experienced significant improvements in back pain, leg pain and the Oswestry Disability Index at 1 year and 2 years postoperatively. Lateral lumbar interbody fusion surgery may be useful for patients with high frailty index,” they wrote.
Study authors included Jong-myung Jung, M.D., of Gachon University Gil Medical Center, Gachon University College of Medicine in Republic of Korea, and Chun Kee Chung, M.D., Chi Heon Kim, Seung Heon Yang, M.D., and Young San Ko, M.D., all of Seoul National University Hospital, Seoul National University College of Medicine in Republic of Korea.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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