Factors affecting the quality of life in the chronic phase of thoracolumbar osteoporotic vertebral fracture managed conservatively with a brace

Hiroyuki Inose; Tsuyoshi Kato; Shoichi Ichimura; Hiroaki Nakamura; Masatoshi Hoshino; Shinji Takahashi; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Takashi Hirai; Toshitaka Yoshii; Kunihiko Takahashi; Atsushi Okawa

doi:10.1016/j.spinee.2022.11.012

Factors affecting the quality of life in the chronic phase of thoracolumbar osteoporotic vertebral fracture managed conservatively with a brace

Spine J. 2023 Mar;23(3):425-432. doi: 10.1016/j.spinee.2022.11.012. Epub 2022 Nov 16.

Authors

Hiroyuki Inose¹, Tsuyoshi Kato², Shoichi Ichimura³, Hiroaki Nakamura⁴, Masatoshi Hoshino⁴, Shinji Takahashi⁴, Daisuke Togawa⁵, Toru Hirano⁶, Yasuaki Tokuhashi⁷, Tetsuro Ohba⁸, Hirotaka Haro⁸, Takashi Tsuji⁹, Kimiaki Sato¹⁰, Yutaka Sasao¹¹, Masahiko Takahata¹², Koji Otani¹³, Suketaka Momoshima¹⁴, Takashi Hirai¹⁵, Toshitaka Yoshii¹⁵, Kunihiko Takahashi¹⁶, Atsushi Okawa¹⁵

Affiliations

¹ Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan. Electronic address: inose.orth@tmd.ac.jp.
² Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan; Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan.
³ Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan.
⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan.
⁵ Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan.
⁶ Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan.
⁷ Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan.
⁸ Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan.
⁹ Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan.
¹⁰ Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan.
¹¹ Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan.
¹² Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan.
¹³ Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295.
¹⁴ Department of Diagnostic Radiology, Centre for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan.
¹⁵ Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan.
¹⁶ Department of Biostatistics, M&D Data Science Centre, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan.

PMID: 36400395
DOI: 10.1016/j.spinee.2022.11.012

Abstract

Background context: Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have closely investigated the factors contributing to the quality of life (QOL) in the chronic phase after thoracolumbar OVFs using detailed radiographic evaluation.

Purpose: This study aimed to identify factors associated with the QOL in the chronic phase after thoracolumbar OVF.

Design: Post hoc analysis of a prospective randomized study.

Patient sample: Participants included 195 patients with fresh thoracolumbar OVF managed conservatively with a brace who were available for radiographic analysis 48 weeks after injury.

Outcome measures: The degree of QOL impairment at 48 weeks after thoracolumbar OVF was assessed using the Japanese three-level version of the EuroQol five-dimensional questionnaire (EQ-5D) score.

Methods: Univariate and multivariate regression analyses were used to evaluate the relationships between the QOL and radiographic factors.

Results: The univariate analysis showed that age, analgesic use, T10/L5 Cobb angle on magnetic resonance imaging (MRI), subsequent vertebral fracture, and nonunion were significantly associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. The multiple regression analysis showed that nonunion, analgesic use, subsequent vertebral fracture, and sacral slope on MRI were independently associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. Receiver operating characteristic analysis for the deterioration of QOL showed that the cutoff value for sacral slope on MRI was 35 degrees.

Conclusions: This study demonstrated that nonunion, subsequent vertebral fracture, and lower sacral slope were independently associated with poorer QOL in the chronic phase of thoracolumbar OVF managed conservatively with a brace. Therefore, improving or preventing these factors in patients with thoracolumbar OVF in the chronic phase may improve the QOL of the affected patients.

Keywords: EQ-5D; Nonunion; Osteoporotic vertebral fractures; Quality of life; Sacral slope; Subsequent vertebral fracture; Thoracolumbar alignment.

Publication types

Randomized Controlled Trial

MeSH terms

Analgesics
Humans
Osteoporotic Fractures* / complications
Osteoporotic Fractures* / diagnostic imaging
Osteoporotic Fractures* / therapy
Prospective Studies
Quality of Life
Spinal Fractures* / complications
Spinal Fractures* / diagnostic imaging
Spinal Fractures* / therapy

Substances

Analgesics