Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study

Ulrich J A Spiegl; Philipp Schenk; Klaus John Schnake; Bernhard W Ullrich; Georg Osterhoff; Max J Scheyerer; Gregor Schmeiser; Martin Bäumlein; Michael A Scherer; Michael Müller; Kai Sprengel; Katja Liepold; Simon Schramm; H-Christopher Baron; Holger Siekmann; Falko Schwarz; Alex Franck; Volker Zimmermann; Sebastian Katscher; Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma

doi:10.1177/21925682221140831

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study

Global Spine J. 2023 Apr;13(1_suppl):36S-43S. doi: 10.1177/21925682221140831.

Authors

Ulrich J A Spiegl¹, Philipp Schenk², Klaus John Schnake^{3

4}, Bernhard W Ullrich^{5

6}, Georg Osterhoff¹, Max J Scheyerer⁷, Gregor Schmeiser⁸, Martin Bäumlein⁹, Michael A Scherer¹⁰, Michael Müller¹¹, Kai Sprengel^{12

13}, Katja Liepold¹⁴, Simon Schramm¹⁵, H-Christopher Baron¹⁶, Holger Siekmann¹⁷, Falko Schwarz¹⁸, Alex Franck¹⁹, Volker Zimmermann²⁰, Sebastian Katscher²¹; Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma

Affiliations

¹ Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
² Department of Science, Research and Education, BG Clinic Bergmannstrost Halle, Halle, Germany.
³ Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.
⁴ Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany.
⁵ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany.
⁶ Department of Trauma and Reconstructive Surgery, BG Clinic Bergmannstrost Halle, Halle, German.
⁷ Department of Orthopaedic and Traumatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
⁸ Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany.
⁹ Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany.
¹⁰ Lehrkörper Medizinische Fakultät der, Technischen Universität München (Med. Fak. TUM), Munich, Germany.
¹¹ Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
¹² University of Lucerne, Hirslanden Clinic St. Anna, Lucerne, Switzerland.
¹³ Department of Trauma, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland.
¹⁴ Department of Spine Surgery, Thuringia Clinic "Georgius Agricola" Saalfeld, Teaching Hospital of the University of Jena, Saalfeld, Germany.
¹⁵ Department of Trauma Surgery, University Hospital Erlangen, Erlangen, Germany.
¹⁶ Department for Paraplegia and Spine Surgery, BG Trauma Center, Tuebingen, Germany.
¹⁷ Clinic of Trauma-, Hand- and Reconstruction Surgery,AMEOS-Clinic Halberstadt, Halberstadt, Germany.
¹⁸ Department of Neurosurgery, - Friedrich Schiller University, Jena University Hospital, Jena, Germany.
¹⁹ Department of Orthopaedics and Trauma Surgery, Regiomed Klinikum Coburg, Germany.
²⁰ Department of Trauma and Orthopedic Surgery, Klinikum Traunstein, Traunstein, Germany.
²¹ Interdisciplinary Center for Spine and Neurotrauma, Sana Klinikum Borna, Borna, Germany.

Abstract

Study design: Multicenter prospective cohort study.

Objective: To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome.

Methods: A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6 weeks.

Results: A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76 years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131 days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups (P < .001) and had significant better TuG compared to hybrid stabilization (P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P > .602, Barthel: P > .252, EQ-5D 5L index value: P > .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits.

Conclusions: Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.

Keywords: OF classification; operative; osteoporosis; spine; vertebral fracture.