Evidence map›Paper›PMID 42562353›Full record

ArticleAsian spine journal2026

Cervical sarcopenia and frailty as complementary predictors of postoperative outcomes after odontoid fracture fixation: a retrospective cohort study in the United States.

Sapan Patel, Hershil Patel, Rohan Iyer Suresh, Bibhas Amatya, Sourabh Vellala, Mario Sahlani, Anthony Kohler Chiu, Hans Prakash, Evan Honig, Usman Zareef and 7 more

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Article in Asian spine journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

17 authors.

Sapan PatelDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Hershil PatelDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Rohan Iyer SureshDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Bibhas AmatyaDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Sourabh VellalaDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Mario SahlaniDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Anthony Kohler ChiuDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Hans PrakashDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Evan HonigDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Usman ZareefDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Ryan CurtoDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Alexander PadovanoDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Louis BivonaDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Daniel Lee CavanaughDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Eugene Young KohDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Steven LudwigDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA. umdorthospine@gmail.com.
Julio Jose JaureguiDepartment of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.

Funding

AO Spine North AmericaBaxterOMEGA
6 · The paper itself

Abstract

STUDY

designRetrospective cohort study. PURPOSE: To compare three cervical sarcopenia metrics and frailty as preoperative predictors of unfavorable postoperative outcomes following surgical fixation of odontoid fractures. OVERVIEW OF LITERATURE: Sarcopenia is increasingly recognized as an indicator of physiologic vulnerability in spine surgery and thoracolumbar trauma. However, its prognostic significance in odontoid fractures remains unclear, and no previous study has directly compared cervical sarcopenia measurement sites in this population.

methodsAdult patients who underwent surgical fixation of traumatic odontoid fractures at a single level I trauma center were retrospectively reviewed. Sarcopenia was quantified on perioperative computed tomography using sternocleidomastoid, prevertebral, and paraspinal cross-sectional area normalized to the C3 vertebral body area. Frailty was assessed using the 5-factor modified frailty index (mFI-5), with hypertension status confirmed through a review of prescribed medications. Associations with postoperative outcomes were evaluated using threshold-based analyses, intercorrelation testing, subgroup analysis of combined low-sarcopenia/high-frailty patients, and an exploratory Combined Sarcopenia-Frailty Score.

resultsThis study included 61 patients (mean age, 61.7 years; 50.8% female). The three sarcopenia metrics were only modestly intercorrelated (Spearman rho, 0.34-0.47), with 46.7%-53.3% overlap among patients in the most sarcopenic quartiles. No individual sarcopenia or mFI-5 threshold independently predicted postoperative outcomes. However, patients in the most sarcopenic quartile on any cervical metric with an mFI-5 ≥2 (n=11) experienced higher rates of mortality, urinary tract infection, pneumonia, and nonunion. In exploratory receiver operating characteristic analysis, the Combined Sarcopenia-Frailty Score exhibited moderate discrimination for significant adverse events, with an area under the curve of 0.73 and an optimal threshold of ≥9.

conclusionsCervical sarcopenia and frailty were not independently associated with adverse outcomes following odontoid fracture fixation. However, their combination identified patients at substantially higher risk for mortality, complications, and nonunion, supporting a potential role for combined preoperative risk stratification (Level of Evidence: level III).

Indexed as

FrailtyOdontoid processPostoperative complicationsRisk assessmentSarcopeniaSpinal fractures

Identifiers

PMID42562353
PMCPMC13547675

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