{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T01:11:00Z","timestamp":1778202660133,"version":"3.51.4"},"reference-count":23,"publisher":"The Korean Spinal Neurosurgery Society","issue":"2","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-neurospine.org"],"crossmark-restriction":true},"short-container-title":["NS"],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:p>Objective: To evaluate whether combining clinical frailty with magnetic resonance imaging (MRI)-derived posterior paraspinal muscle degeneration identifies perioperative risk phenotypes in adults aged \u226575 years undergoing lumbar fusion.Methods: We retrospectively studied patients aged \u226575 years undergoing lumbar fusion with preoperative lumbar MRI. Frailty was assessed using the Fried phenotype (frail: score \u22653). Posterior paraspinal muscle degeneration across L1\u2013S1 was quantified using automated segmentation and a composite posterior frailty index (PFI); severe degeneration was defined as the upper quartile of PFI. Patients were classified into 4 frailty\u00d7muscle phenotypes. Primary outcomes were any in-hospital complication and prolonged length of stay (LOS \u226516 days).Results: Among 248 patients, phenotypes A\u2013D (A, nonfrail\/nonsevere; B, frail\/nonsevere; C, nonfrail\/severe; D, frail\/severe) comprised 132, 54, 20, and 42 patients, respectively. Any in-hospital complication occurred in 18.2% of phenotype A compared with 50.0%\u201357.1% in phenotypes B\u2013D (p&lt;0.001). Prolonged LOS (\u226516 days; cohort 75th percentile) occurred in 0.8% of phenotype A versus 38.9% (B), 35.0% (C), and 78.6% (D) (p&lt;0.001), corresponding to absolute risk increases of +34.2 to +77.8 percentage points. After adjustment, higher-risk phenotypes remained independently associated with increased odds of any complication and prolonged LOS; however, the prolonged-LOS odds estimates were imprecise due to sparse events in the reference group. Phenotype was not independently associated with 90-day readmission. Pain improvement (\u0394VAS [visual analogue scale]) was attenuated in phenotypes B and D, while differences in \u0394ODI (Oswestry Disability Index) were not statistically significant.Conclusion: Integrating frailty and MRI-based posterior paraspinal degeneration provides actionable stratification of complication and prolonged LOS risk after lumbar fusion in older adults.<\/jats:p>","DOI":"10.14245\/ns.2551838.919","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:07:03Z","timestamp":1777421223000},"page":"242-254","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Frailty-Muscle Phenotypes Predict Outcomes After Lumbar Fusion in Adults Aged \u226575 Years: A Retrospective Cohort Study"],"prefix":"10.14245","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3843-5483","authenticated-orcid":true,"given":"Ma Chao","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"},{"name":"Department of Orthopedics, South China Hospital, Medical School, Shenzhen University, Shenzhen, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1943-846X","authenticated-orcid":true,"given":"Xiangyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3473-2966","authenticated-orcid":true,"given":"Shuaikang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8128-0969","authenticated-orcid":true,"given":"Xiaolong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-2648","authenticated-orcid":true,"given":"Chao","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9799-037X","authenticated-orcid":true,"given":"Yuxi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2811-1233","authenticated-orcid":true,"given":"Shibao","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China"},{"name":"National Clinical Research Center for Geriatric Diseases, Beijing, 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between posterior paraspinal muscle fat infiltration and early conversion to lumbar spinal fusion following decompression surgery","author":"Chiapparelli","year":"2025"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-16710-5"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07777-4"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3390\/jimaging10110262"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1097\/pts.0000000000000987"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.14444\/8531"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0313528"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/as9.0000000000000496"},{"key":"ref21","first-page":"1706","volume-title":"90-day readmission after lumbar spinal fusion surgery in new york state between 2005 and 2014: a 10-year analysis of a statewide 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