Acta Innovations · Nov 7, 2026

Sarcopenia and Frailty in Lumbar Spinal Stenosis: Assessment, Clinical Impact, and Implications for Surgical Decision-Making

By Asikin AIZ, Widhiyanto L, Moeljono A

Lumbar spinal stenosis (LSS) is the most common indication for spine surgery in older adults, a population in which sarcopenia and frailty are also highly prevalent. This review aimed to summarize how both conditions are assessed in LSS, how often they occur, and how they influence treatment outcomes, with particular attention to endoscopic and minimally invasive decompression. We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for studies published between January 2016 and September 2026; after removal of duplicates, 486 records were screened and 125 studies were included. Sarcopenia was present in approximately 14%–27% of patients with LSS, whereas frailty was reported in approximately 22%–59%, depending on the instrument and the age of the cohort. Both conditions were associated with more severe pain, greater disability, and poorer walking capacity before treatment, and low muscle function was often more relevant than low muscle mass. After surgery, frailty mainly increased the risk of medical complications. Most frail or sarcopenic patients still improved after decompression, although their gains in back pain, function, and daily activity were frequently smaller. Following endoscopic decompression, leg pain improved to a comparable degree regardless of muscle status, while improvement in back pain and function lagged behind in sarcopenic patients. The available evidence was largely retrospective and derived from East Asian cohorts. Sarcopenia and frailty should therefore inform patient counseling and the choice of procedure rather than serve as reasons to exclude patients from surgery. We recommend simple screening using grip strength, gait speed, and a frailty scale, and we call for prospective studies with standardized definitions, including studies from Southeast Asia.

doi.org/10.62441/actainnovations.vi.3527 Open access Interventions