Vertebral compression fractures managed with brace: risk factors for progression

Area of Science:

• Orthopedics
• Traumatology
• Radiology

Background:

• Vertebral compression fractures (VCFs) are common, particularly in older adults.
• Conservative management with bracing is a standard treatment approach.
• Understanding factors influencing VCF progression is crucial for optimizing patient outcomes.

Purpose of the Study:

• To identify independent risk factors for the progression of vertebral compression fractures (VCFs) in patients managed conservatively with bracing.
• To analyze the association between identified risk factors and VCF progression.

Main Methods:

• A retrospective case-control study was conducted.
• Included patients over 50 years old with thoracic or lumbar VCFs (T5-L5) treated with a brace, excluding oncological cases.
• 489 patients with complete follow-up were analyzed.

Main Results:

• VCF progression, defined as increased vertebral body collapse, occurred in 29.9% of cases.
• Independent risk factors for progression included male gender (OR 1.6), AOSpine type A3 fracture (OR 2.7), thoracolumbar junction location (OR 1.7), and incorrect brace use (OR 3.5).
• Progression was associated with worse pain control.

Conclusions:

• Male gender, AOSpine type A3 fractures, thoracolumbar location, and improper brace use are significant risk factors for VCF progression.
• These findings suggest that alternative treatments like percutaneous vertebral augmentation may be beneficial for selected patients to prevent progression.