The analysis of MSTMOVCF (Multi-segment thoracolumbar mild osteoporotic fractures surgery or conservative treatment) based on ASTLOF (the assessment system of thoracolumbar osteoporotic fracture)

Jin Peng Du,Ji Jun Liu,Jing Zhang,Jia Nan Zhang,Yan Sheng Huang,Ding Jun Hao,Yong Fan

doi:10.1038/s41598-018-26562-7

Jin Peng Du, Ji Jun Liu + Show 5 more

Open Access

https://doi.org/10.1038/s41598-018-26562-7

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Abstract

To investigate the issue that conservative or surgical treatment for multi-segmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF) by applying the assessment system of thoracolumbar osteoporotic fracture (ASTLOF). A single-center prospective cohort study was designed to enroll elderly patients with MSTMOVCF from June 2013 to June 2016, which were divided into conservative and surgery group. The primary outcomes were Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score, with secondary outcomes including SF-36 and imaging measures such as height of anterior and middle column, Beck value, complications. A total of 470 patients with MSTMOVCF were enrolled. 193 patients underwent surgery of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and 277 patients underwent conservative treatment. The VAS score of operation group was significantly lower than that of conservative group (P < 0.0001, for all). The ODI score of the operation group was significantly lower than that of conservative group (P < 0.0001, for all). The SF-36 score, height of anterior and middle column, Beck value in the operation group were higher than those in conservative group (P < 0.0001, for all) at 1-year follow-up. MSTMOVCF underwent surgery can achieve great short-term clinical results. The patient with the sum of revised ASTLOF scores of multiple injured vertebrae ≥ 5 was recommended for surgery.

Highlights

Osteoporotic vertebral compression fractures (OVCF) are more common in the elderly[1], it often caused by low-energy damage
Only 470 patients were eventually enrolled in the study, with an average age of 71.0 ± 10.6 years, of whom 352 were women (74.9%). 277 cases were included in the conservative group, with an average age of 71.5 ± 11.3 years, of whom 205 (74.0%) were women; 193 were included in the operation group, with an average age of 69.7 ± 9.9 years, of whom 147 (76.2%) were women
There were no significant differences between the conservative group and the surgical group in terms of sex, age, BMI, the number of fractured vertebrae, the proportion of noncontignous thoracolumbar fractures

Summary

Introduction

Osteoporotic vertebral compression fractures (OVCF) are more common in the elderly[1], it often caused by low-energy damage. The classification of OVCF includes Chinese Medical Association classification (compression type, burst type), Genant semi-quantitative method and Heini classification[3,4] These classifications are mainly based on fracture morphology characteristic and (or) stability present on X-ray films, but as a result of evaluation index is single, the severity of osteoporotic fracture can’t be assessed, which will inevitably affect the treatment and prognosis of fractures. Even there are still many spinal surgeons based on the TLICS score to determine osteoporotic fractures require surgery or not, but which is wrong, because the TLICS score is primarily used for thoracolumbar fractures caused by high energy damage.

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