Bernhard W. Ullrich (Halle / DE), Philipp Schenk (Halle / DE), Alexander Franck (Coburg / DE), Jessy Wiedemann (Dresden / DE), Sebastian Katscher (Borna / DE), Klaus Schnake (Erlangen / DE), Georg Osterhoff (Leipzig / DE), Max Scheyerer (Düsseldorf / DE), Gregor Schmeiser (Hamburg / DE), Martin Bäumlein (Marburg / DE), Michael Scherer (Munich / DE), Kai Sprengel (Lucerne / CH), Katja Liepold (Saalfeld / DE), Simon Schramm (Erlangen / DE), Christopher Baron (Tübingen / DE), Holger Siekmann (Halberstadt / DE), Falko Schwarz (Jena / DE), Volker Zimmermann (Traunstein / DE), Ulrich Spiegl (Munich / DE), Arbeitsgruppe Osteoporotische Frakturen Sektion Wirbelsäule der DGOU (Berlin / DE)
Objective:
The study evaluated the effect of the chosen therapy on the sagittal profile as well as the clinical outcome of osteoporotic fractures of the thoracolumbar spine.
Methods:
To analyze thoracolumbar osteoporotic vertebral compression fractures (TOVCF), patient data from the EOFTT-study was used. Treatment options—conservative management (C), augmentation (A: Kypho- or Vertebroplasty), and instrumentation (I)—were compared radiologically using the bisegmental Cobb angle (biCA). Therefore, 3 defined time intervals were evaluated: day of treatment decision (DTD) to discharge (DIS), DIS to follow-up (FU), and DTD to FU. Outcome parameters were Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, EQ-5d-5L, and Time Up and Go- Test (TuG).
Results
From DTD to DIS, 364 patients were included. Both surgical interventions improved significantly in biCA (A: p=0.002; I: p < 0,001).
270 patients could be included for DTD to DIS and FU. The biCA reduced from DIS to FU across all groups (p= 0.685). BiCA improved significantly after I comparing DTD to FU, while patients after A and C have not. The ODI and VAS improved from DTD to DIS and again to FU, with a significant interaction effect. TuG improved significantly, particularly in conservatively treated and instrumented patients, at FU.
Conclusion
The more clinically limited patients are due to an TOVCF, the more likely they are to receive surgical treatment.
While all treatment groups initially showed reduced pain and an improved outcome, only the conservatively treated and instrumented patients demonstrated a lasting effect with further improvement at FU. The findings could be interpreted as an effect of the sustained correction of fracture-related kyphosis.
In our view, the poorer clinical outcome of stand-alone A over time calls into question the indication for these surgical methods and suggests a preference for I in choosing the surgical approach.
nothing to disclose
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