Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support

Clinical article

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Object

External supports serve as a traditional treatment option for osteoporotic vertebral fractures (OVFs). However, the role of external supports in the treatment of OVF remains inconclusive. The purpose of this study was to determine the role of a rigid external support in the healing of OVFs by prospectively evaluating union (fracture settling) rates and prognostic variables for patients suffering from an incident OVF.

Methods

Fifty-five patients with acute back pain were enrolled in this study after being diagnosed with an OVF based on MRI findings. Patients were treated using a plastic thoracolumbosacral orthosis (TLSO) and underwent follow-up at 2, 3, and 6 months. Vertebrae were referred to as “settled” when there was no dynamic mobility on sitting lateral and supine lateral radiographs. At the time of the 3- and 6-month follow-up visits, the patients were divided into 2 groups, the “settled group” and the “unsettled group.” Patients in these groups were compared with regard to clinical and radiographic features.

Results

Of the 55 patients enrolled, 53 patients were followed up for 6 months. There were 14 men and 39 women with an average age of 75.3 years. Fracture settling of the affected vertebra was defined in 54.7% of the patients at 2 months, in 79.2% at 3 months, and in 88.7% at 6 months. All 5 components of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire improved significantly both at 3 months and 6 months. Patients in the unsettled group exhibited a statistically greater likelihood of having fractures at the thoracolumbar junction, Type A3 fractures, and fractures with a diffuse low-intensity area on T2-weighted MRI studies at 3 months. In contrast, at 6 months, the only statistically significant difference between the groups was patient age.

Conclusions

The biomechanical disadvantages of OVFs (location, type, and size) adversely influencing the fracture healing were overcome by the treatment using a TLSO within 6 months. The authors' findings show that a TLSO plays a biomechanical role in the healing of OVFs.

Abbreviations used in this paper:BMD = bone mineral density; BMI = body mass index; JOABPEQ = Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; OVF = osteoporotic vertebral fracture; TLSO = thoracolumbosacral orthosis.
Article Information

Contributor Notes

Address correspondence to: Satoshi Kawaguchi, M.D., Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. email: kawaguch@sapmed.ac.jp.Please include this information when citing this paper: published online August 31, 2012; DOI: 10.3171/2012.7.SPINE122.
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