Degenerative cervical myelopathy (DCM), which encompasses conditions such as cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL), is a condition that causes compressive myelopathy in the cervical spine [1]. Although the etiology of DCM is multifactorial, aging has been recognized as a significant contributing factor [1]. With the continued aging of the global population, the decline in mobility and increased risk of falls among older adults has significantly impacted their healthy life expectancy [2]. Given that DCM often decreases lower extremity function with increasing the risk of falls, the importance of managing DCM has become increasingly recognized [1,3].

Frailty, which is characterized as a state in which the health condition of the older adults becomes fragile, is a crucial concept in an aged society, and their resilience to illnesses and functional decline is reduced [4]. With the continued aging of the global population, the screening and management of frailty have become extremely important; however, numerous assessment methods for frailty have been reported [5]. The modified frailty index (mFI), a simplified version of the original frailty index, had been designed specifically to assess frailty in patients undergoing surgery [5,6]. Various types of mFI have been proposed, among which the 11-point mFI (mFI-11) is particularly versatile [6]. Recently, the simplified mFI-5 has also become frequently used [6]. Previous studies have reported that frailty was associated with worse function and quality of life in patients with DCM [7]. Furthermore, evidence shows that frailty has adverse effects on the surgical outcomes of patients with DCM [7]. Nonetheless, reports have also shown that older patients showed significant improvement in quality of life after surgery for DCM despite the presence of frailty, prompting ongoing debates regarding this issue [8].

Locomotive syndrome (LS) refers to a condition wherein musculoskeletal disorders make it difficult to perform activities necessary for daily living, potentially progressing to a state requiring care in the future [9]. This syndrome is primarily caused by diseases and the functional decline in the bones, joints, and muscles associated with aging [9]. DCM has often been categorized under LS, with reports also showing improvements in the severity of LS following surgery [10]. Previous studies on the relationship between frailty and LS have frequently shown an overlap between both conditions [11,12]. In fact, studies show that older individuals with frailty have been considered to be at higher risk for developing LS and vice versa [11,12]. However, the interaction between frailty and LS in older patients with DCM remains unclear. Hence, the current study primarily aimed to determine the characteristics of older DCM patients with frailty, including their surgical outcomes, specifically investigating the association between frailty and LS in older DCM patients undergoing surgery.