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Abstract
Objectives
To validate a treatment plan by analyzing the clinical outcome of conservative treatment for patients with osteoporotic vertebral compression fractures at thoracolumbar junctions.
Summary of Literature Review
Osteoporotic vertebral compression fractures, without neurological symptoms, have been treated by conservative management; however, serious sequelae of the osteoporotic vertebral compression fractures have been reported by many investigators.
Materials and Methods
We evaluated 83 cases; 68 patients had an average age of 71.1 years (58 to 99 years). After conservative treatment of the osteoporotic compression fractures, and based on the clinical outcome derived from a 10-point pain rating scale at last follow up, the group was subdivided into two groups. Group A (N=28): had a score of above five points on the pain scale. Group B (N=55): had a score of less than five points on the pain scale. Evaluation of the correlation between the clinical outcome and factors affecting outcome such as vertebral body height loss, change in height loss, BMD and bracing were recorded at the initial and follow up assessment.
Results
The mean VAS score was 3.20 1.62, and the mean compression ratio was 24.74 12.03% at injury and 21.68 11.43% at the last followup. The mean compression ratio at injury was 27.67 10.50% in group A and 23.25 10.57% in group B. The mean compression ratio at the last followup was 53.43 13.31% for group A and 42.86 13.74% for group B. The change in compression ratio was 25.76 12.68% in group A and 19.60 10.25% in group B. The mean BMD was -3.63 1.16 for group A and -2.80 1.10 for group B. The compression ratio at last followup, change of compression ratio and BMD were significantly different in comparisons between group A and B (p=0.001, 0.031, 0.003, respectively).
Conclusion
The clinical outcome of osteoporotic compression fractures was related to the compression ratio, and the compression ratio was related with BMD. Patients with osteoporotic compression fractures with a compression ratio of more than 30% and a T-score from the BMD of less than -3.5 require active treatment.
REFERENCES
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Figures and Tables%
Fig. 1.
The schematic presentation to the degree of compression ratio(F) of injuried spinal body, F=(1-2b/(a+c))×100.
Table 1.
Distribution of fractures level
| Level | Male | Female | Total |
|---|---|---|---|
| T11 | 00 | 05 | 05 |
| T12 | 02 | 25 | 27 |
| L1 | 06 | 29 | 35 |
| L2 | 03 | 13 | 16 |
| Total | 11 | 72 | 83 |
Table 2.
Clinical and radiologic data of group A and group B
| Group A∗ | Group B† | p-value | |
|---|---|---|---|
| Age | 72.39±9.85% | 70.51±5.71% | p>0.05 |
| Male : Female | 6:22 | 5:50 | p>0.05 |
| T-score of BMD | -3.63±1.16% | -2.80±1.10% | p=0.003 |
| Compression ratio | |||
| Initial | 27.67±10.50% | 23.25±10.57% | p=0.076 |
| Last F/U | 53.43±13.31% | 42.86±13.74% | p=0.031 |
| Change | 25.76±12.68% | 19.60±10.25% | p=0.001 |
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