North American Spine Society Journal · Sep 12, 2025

A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance

By Bangash AH, Fluss R, Kirnaz S et al.

BACKGROUND: Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance. METHODS: We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications. RESULTS: Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions. CONCLUSIONS: Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.

doi.org/10.1016/j.xnsj.2025.100794Open accessPubMed 41140524Biomarkers