Aims
- A concise preoperative risk stratification tool that links frailty to concrete postoperative risks in cervical deformity surgery
15 Components
- High Charlson Comorbidity Index (CCI) score
- History of pulmonary disease
- History of depression
- Difficulty sleeping more than 6 hours per night
- Anxiety (EQ-5D derived)
- Difficulty walking / unsteady gait (EQ-5D derived)
- Leg weakness
- Use of an assistive device for ambulation (e.g., cane, walker)
- Prior cervical spine surgery
- Presence of myelopathy
- History of cardiac disease
- History of diabetes
- History of osteoporosis
- Smoking history
- Elevated body mass index / obesity
Scoring
- Each deficit is scored 0 (absent) or 1 (present), max score of 15.
- Not Frail (NF): mCD-FI <0.3
- Frail: mCD-FI 0.3–0.5
- Severely Frail (SF): mCD-FI >0.5
Clinical significance
- Predicts complications:
- frail patients (mCD-FI 0.3–0.5) have higher odds of superficial surgical site infection and vascular complications than non‑frail patients.
- Identifies very high‑risk patients:
- Severely frail patients (mCD-FI >0.5) have markedly increased odds of cardiac arrest and mortality compared with frail and non‑frail groups.
- Correlates with resource use
- Higher mCD-FI scores are associated with longer inpatient hospital stays (NF ≈5.6 days, frail ≈8.4 days, severely frail ≈14.0 days).
- Tracks patient‑centred outcomes:
- Increasing frailty is associated with worse neck pain, higher Neck Disability Index scores, and lower EQ‑5D health‑related quality of life.
- Supports surgical decision‑making and counseling:
- by compressing 15 deficits into a 0–1 score with defined cut‑points (<0.3, 0.3–0.5, >0.5), it provides an objective, quick way to discuss risk, guide patient selection, and set expectations.
- Highlights modifiable targets:
- because it includes factors such as anxiety, unsteady gait, and leg weakness, it can help frame prehabilitation goals and the aim of surgery to reduce postoperative frailty burden.