European Spine Journal

, Volume 28, Issue 1, pp 46–54 | Cite as

The prevalence and impact of frailty in patients with symptomatic lumbar spinal stenosis

  • Ho-Joong Kim
  • Saejong Park
  • Soo-Hyun Park
  • Jeong Hyun Lee
  • Bong-Soon Chang
  • Choon-Ki Lee
  • Jin S. YeomEmail author
Original Article



To investigate the prevalence of frailty in patients with symptomatic lumbar spinal stenosis (LSS) and a propensity score-matched control group, and to analyze the association between symptomatic LSS and frailty.


This study included 2 groups: 1 consisting of patients with symptomatic LSS (LSS group) and the other including healthy elderly subjects without degenerative spinal disease (control group). Baseline sociodemographic data, variables regarding frailty assessment, and clinical outcomes were collected. The frailty was assessed with Fried criteria. Between the LSS and control groups, the prevalence of frailty was compared. Among all participants, risk factors for frailty were identified using multivariate logistic regression.


Totally, 843 subjects participated (142 in LSS group and 701 in control group) in this study. After the propensity score matching (142 in each group), the LSS group had significantly higher prevalence of frail than the control group (P < 0.001): 59 (41.5%) participants in the LSS group were frail, whereas 10 (7.0%) participants in the control group were frail. Within LSS group analysis showed that participants with frailty had significantly higher disability and lower quality of life compared to those in a robust state. Among all participants, LSS and age were found to be significant risk factors for frail in multivariate logistic regression model.


The present study highlights a strong association between symptomatic LSS and frailty. Furthermore, symptom severity and disability caused by LSS are significantly related to frailty. Therefore, early detection and appropriate treatment for frailty in patients with LSS is important.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Frailty Lumbar spinal stenosis Fried frailty criteria Propensity score matching 



Ho-Joong Kim, MD, and Saejong Park, PhD, contributed equally to the writing of this article. This study was supported by research grants from the Korea Sports Promotion Foundation and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5710_MOESM1_ESM.pptx (138 kb)
Supplementary material 1 (PPTX 137 kb)


  1. 1.
    Keevil VL, Romero-Ortuno R (2015) Ageing well: a review of sarcopenia and frailty. Proc Nutr Soc 74(4):337–347. CrossRefGoogle Scholar
  2. 2.
    Cooper Z, Rogers SO Jr, Ngo L, Guess J, Schmitt E, Jones RN, Ayres DK, Walston JD, Gill TM, Gleason LJ, Inouye SK, Marcantonio ER (2016) Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 64(12):2464–2471. CrossRefGoogle Scholar
  3. 3.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762. CrossRefGoogle Scholar
  4. 4.
    Kim HJ, Lee KW, Cho HG, Kang KT, Chang BS, Lee CK, Yeom JS (2015) Indirect effects of decompression surgery on glycemic homeostasis in patients with type 2 diabetes mellitus and lumbar spinal stenosis. Spine J 15(1):25–33. CrossRefGoogle Scholar
  5. 5.
    Kim H-J, Lee H-M, Chun H-J, Kang K-T, Kim H-S, Park J-O, Moon E-S, Park K-H, Moon S-H (2009) Restoration of bone turnover rate after decompression surgery in patients with symptomatic lumbar spinal stenosis: preliminary report. Spine (Philadelphia, Pa 1976) 34(18):E635–E639CrossRefGoogle Scholar
  6. 6.
    Amundsen T, Weber H, Lilleås F, Nordal HJ, Abdelnoor M, Magnaes B (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine (Philadelphia, Pa 1976) 20(10):1178–1186CrossRefGoogle Scholar
  7. 7.
    Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358(8):818–825CrossRefGoogle Scholar
  8. 8.
    Park S, Kim HJ, Ko BG, Chung JW, Kim SH, Park SH, Lee MH, Yeom JS (2016) The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis. Bone Jt J 98-b(8):1093–1098. CrossRefGoogle Scholar
  9. 9.
    Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF, North American Spine S (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8(2):305–310. CrossRefGoogle Scholar
  10. 10.
    Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Philadelphia, Pa 1976) 35(21):1919–1924CrossRefGoogle Scholar
  11. 11.
    Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine (Philadelphia, Pa 1976) 25(22):2940–2952CrossRefGoogle Scholar
  12. 12.
    Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35(11):1095–1108CrossRefGoogle Scholar
  13. 13.
    Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343CrossRefGoogle Scholar
  14. 14.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  15. 15.
    Chun MY (2012) Validity and reliability of korean version of international physical activity questionnaire short form in the elderly. Korean J Fam Med 33(3):144–151. CrossRefGoogle Scholar
  16. 16.
    Gary R (2012) Evaluation of frailty in older adults with cardiovascular disease: incorporating physical performance measures. J Cardiovasc Nurs 27(2):120–131. CrossRefGoogle Scholar
  17. 17.
    Hoogendijk EO, van Hout HP, Heymans MW, van der Horst HE, Frijters DH, Broese van Groenou MI, Deeg DJ, Huisman M (2014) Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands. Ann Epidemiol 24(7):538–544. CrossRefGoogle Scholar
  18. 18.
    Kim RB, Garcia RM, Smith ZA, Dahdaleh NS (2015) Impact of resident participation on outcomes following single-level anterior cervical diskectomy and fusion: an analysis of 3,265 patients from the ACS-NSQIP database. Spine (Phila Pa 1976). Google Scholar
  19. 19.
    Theou O, Brothers TD, Rockwood MR, Haardt D, Mitnitski A, Rockwood K (2013) Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans. Age Ageing 42(5):614–619. CrossRefGoogle Scholar
  20. 20.
    Chang YW, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, Kao TW (2012) Frailty and its impact on health-related quality of life: a cross-sectional study on elder community-dwelling preventive health service users. PLoS One 7(5):e38079. CrossRefGoogle Scholar
  21. 21.
    Wise BL, Parimi N, Zhang Y, Cawthon PM, Barrett-Connor E, Ensrud KE, Lane NE (2014) Frailty and hip osteoarthritis in men in the MrOS cohort. J Gerontol A Biol Sci Med Sci 69(5):602–608. CrossRefGoogle Scholar
  22. 22.
    Castell MV, van der Pas S, Otero A, Siviero P, Dennison E, Denkinger M, Pedersen N, Sanchez-Martinez M, Queipo R, van Schoor N, Zambon S, Edwards M, Peter R, Schaap L, Deeg D (2015) Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord 16:359. CrossRefGoogle Scholar
  23. 23.
    Misra D, Felson DT, Silliman RA, Nevitt M, Lewis CE, Torner J, Neogi T (2015) Knee osteoarthritis and frailty: findings from the Multicenter Osteoarthritis Study and Osteoarthritis Initiative. J Gerontol A Biol Sci Med Sci 70(3):339–344. CrossRefGoogle Scholar
  24. 24.
    Tom SE, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Gehlbach SH, Greenspan SL, Hooven FH, Nieves JW, Pfeilschifter J, Roux C, Silverman S, Wyman A, LaCroix AZ (2013) Frailty and fracture, disability, and falls: a multiple country study from the global longitudinal study of osteoporosis in women. J Am Geriatr Soc 61(3):327–334. CrossRefGoogle Scholar
  25. 25.
    Kim HJ, Park JW, Chang BS, Lee CK, Yeom JS (2015) The influence of catastrophising on treatment outcomes after surgery for lumbar spinal stenosis. Bone Jt J 97-b(11):1546–1554. CrossRefGoogle Scholar
  26. 26.
    Kim HJ, Kim SC, Kang KT, Chang BS, Lee CK, Yeom JS (2014) Influence of educational attainment on pain intensity and disability in patients with lumbar spinal stenosis: mediation effect of pain catastrophizing. Spine 39:E637–E644. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Spine Center and Department of Orthopedic SurgerySeoul National University College of Medicine and Seoul National University Bundang HospitalSungnamRepublic of Korea
  2. 2.Division of Sports ScienceKorea Institute of Sports ScienceSeoulRepublic of Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University College of Medicine and Seoul National University HospitalSeoulRepublic of Korea

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