Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures—results of the EOFTT study

Abstract

Aim Osteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed. Purpose Patients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed. Methods A total of 518 patients’ aged 75 ± 10 (41–97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness. Results Five (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients. Conclusion Fracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.

Minimalinvasive Chirurgie bei Wirbelsäulentrauma – Unterschiede der Versorgungstechniken zwischen jungen und alten Patienten

“…bei Fehlen von starken degenerativen oder ankylosierenden Veränderungen mit diesem Verfahren operativ behandelt werden. Im Rahmen der prospektiven Evaluationsstudie zur OF-Klassifikation und OF-Score war die Hybridfixation das am häufigsten bei osteoporotischen Frakturen angewendete Verfahren [35].…”

“…Bei operativer Indikation kommen hier Augmentationsverfahren oder eine Hybridfixation zur Anwendung. OF 4 Frakturen werden überwiegend operativ und OF 5 Frakturen nahezu grundsätzlich operativ behandelt [35].…”

OF2 # mit sekundärer Sinterung – konservative Therapie

“…Zusammenfassend besteht bei der OF 2 Fraktur auch bei einer Nachsinterung an sich noch keine Operationsindikation, sofern nicht gleichzeitig eine klinische Verschlechterung eintritt. Dabei dient der OF-Score als validiertes und zur objektiven Beurteilung geeignetes Instrument, um eine therapeutische Entscheidung zu treffen [10].…”

Impact of anxiety during hospitalization on the clinical outcome of patients with osteoporotic thoracolumbar vertebral fracture: a prospective multicentric study

“…Additionally, a score for treatment decisions and treatment recommendations for each fracture type were developed (11). With the aim of evaluating the scoring system, the "Clinical Evaluation of the OF-Score for Therapy-Planning and Treatment-Recommendations for osteoporotic fractures of the thoracolumbar spine" study (EOFTT) was conducted and revealed good clinical results for therapy following this recommendation and adapted to fracture severity according to OF classi cation (12).…”