Spine Surgery and Related Research · Oct 28, 2026

Psychological Burden in Adult Spinal Deformity Is Associated with Disability, Frailty, and Physical Function Rather Than Radiographic Severity

By Miyamoto A, Ito K, Mizukoshi R et al.

Introduction: Psychological burden may influence perceived disability in adult spinal deformity (ASD), but its relationships with physical dysfunction, frailty, and radiographic severity remain unclear. This study examined clinical correlates of the patient-rated Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP-P) in primary ASD. We hypothesized that BS-POP-P would be more closely associated with disability, health-related quality of life (HRQOL), frailty, and physical function than with radiographic severity.Methods: This retrospective cross-sectional study included 142 consecutive patients with primary ASD examined between 2023 and 2025. The primary outcome was BS-POP-P. Variables included Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), gait performance, grip strength, skeletal muscle index, muscle mass, modified frailty index-11, exploratory laboratory/biological aging markers, and spinopelvic radiographic parameters. Spearman correlation, Kruskal-Wallis testing, multivariable regression, construct-overlap sensitivity analyses, multiple imputation, operative-status stratification, and sex-adjusted sensitivity analyses were performed.Results: Median age was 71 years; 124 patients were female, and 78 were operative candidates. Median BS-POP-P was 16, and 70 patients had high BS-POP-P. BS-POP-P correlated most strongly with EQ-5D and ODI, followed by 10-m effort walk time, muscle mass, grip strength, skeletal muscle index, and frailty. Radiographic correlations were negligible. The demographic-plus-radiographic model explained almost no variance, whereas patient-reported outcome measures (PROMs) -based models explained more variance. After removing overlapping BS-POP-P items, correlations persisted with ODI and EQ-5D, whereas radiographic correlations remained weak. In sex-adjusted sensitivity analyses, female sex was not independently associated with BS-POP-P after adjustment for PROMs and physical/frailty variables.Conclusions: In primary ASD, BS-POP-P was associated with disability, HRQOL, impaired physical function, reduced muscle reserve, and frailty, but not radiographic severity. These findings should be interpreted as cross-sectional associations rather than evidence of established prognostic utility.

doi.org/10.22603/ssrr.2026-0284Open accessPowered by J-STAGEBiomarkers