What this means
➢ Adult spinal deformity (ASD) outcomes are poorly predicted by chronological age alone; biological age markers, including frailty indices, sarcopenia measurements, and bone quality metrics, provide better risk assessment. ➢ Systemic frailty tools (modified Frailty Index, ASD-Frailty Index [ASD-FI], Risk Analysis Index) predict perioperative morbidity and discharge disposition more accurately than age-based models do.
A plain-English summary is on its way. Until then, this is the start of the authors' own summary.
- Who it was tested in
- People
- Kind of research
- A summary of earlier studies
The science
- Original title
- The Role of Biological Age in Adult Spinal Deformity Surgery.
- Authors
- Salazar LM, Vaja S, Samartzis D et al.
- Journal
- The Journal of bone and joint surgery. American volume
- Published
- Oct 22, 2026
- Study type
- Review · in humans
- PMID
- 42905115 ↗
Abstract
➢ Adult spinal deformity (ASD) outcomes are poorly predicted by chronological age alone; biological age markers, including frailty indices, sarcopenia measurements, and bone quality metrics, provide better risk assessment. ➢ Systemic frailty tools (modified Frailty Index, ASD-Frailty Index [ASD-FI], Risk Analysis Index) predict perioperative morbidity and discharge disposition more accurately than age-based models do. ➢ Musculoskeletal assessments, psoas and paraspinal muscle cross-sectional areas, fatty infiltration grading, and computed tomography-derived Hounsfield unit thresholds identify patients with sarcopenia and osteoporosis at elevated risk for proximal junctional failure, implant fracture, and pseudarthrosis. ➢ Artificial intelligence and machine learning can automate osteosarcopenia quantification and define pelvic incidence-dependent alignment phenotypes, which may personalize correction targets. ➢ Integrating multidimensional biological age profiles into preoperative planning facilitates tailored surgical aggressiveness, age-appropriate and morphology-appropriate alignment goals, and targeted prophylactic strategies, paving the way toward a physiology-driven model in ASD surgery.
Salazar LM, Vaja S, Samartzis D et al. The Role of Biological Age in Adult Spinal Deformity Surgery. The Journal of bone and joint surgery. American volume. 2026. doi:10.2106/JBJS.25.01324. PMID: 42905115. https://pubmed.ncbi.nlm.nih.gov/42905115/