Treatment and outcome of osteoporotic OF3 vertebral fractures: results from the prospective multicenter EOFTT study

The number of osteoporotic thoracolumbar vertebral fractures (OVCF) is steadily increasing. Incomplete burst type fractures of type OF3 represent a significant proportion of OVCF. The aim of this study is therefore to evaluate the different treatment modalities of OF3 fractures.

A prospective multicenter evaluation of the osteoporotic fracture classification, treatment score and therapy recommendations (EOFTT) was conducted from 2017 to 2020. Patients with OF3 fractures and a minimum follow-up of 6 weeks were included. The exclusion criteria were dementia, malignancies and a history of surgical stabilization or fusion in the fracture region. Before treatment (TD, day of treatment decision) and at last follow-up (FU), the OF score and the following parameters were collected: VAS, Timed Up & Go test (TuG), ODI, Eq. 5D 5 L and complications.

A total of 218 patients with OF3 fractures and mean age of 75 ± 10 years (range 41-96, female 73%) were examined. Conservative treatment was performed in 73 (33%) patients (VAS 4,3, TuG 19´´, ODI 0,55, Eq. 5D 5 L 0,51). Surgical treatment strategies were mainly performed as isolated cementaugmentation (n = 65; 30% - VAS 6,9, TuG 26´´, ODI 0.69, Eq. 5D 5 L 0,33) and short-segment hybrid stabilization (n = 80, 37% - VAS 6,8, TuG 31´´, ODI 0,74, Eq. 5D 5 L 0,64). The time points for assement of the parameters before and after treatment were the day of treatment decision TD (before) and the last available follow up FU (minimum 6 weeks, maximum 12 months - mean FU in the conservative group 6 ± 5 months, mean FU in surgical group 8 ± 5 months). Surgically treated patients reported significantly worse pain (p < 0.001), reduced mobility (TuG p < 0.001) and higher functional limitations (ODI, p < 0.001) before treatment. Patients benefited from all main treatment strategies and improved significantly (p < 0.001), with surgically treated patients showing greater improvement following hybrid stabilization compared with augmentation alone. General complications occured more frequently in surgical group (22,4% vs. 2,7%), specific surgical complications occured in 5/145 patients (3,5%) with 3/145 requiring revision surgery (2,1%).

OF3 fractures respond to both conservative and surgical treatment. Isolated cementaugmentation and percutaneous bisegmental hybrid stabilization are the main surgical strategies. High OF scores including severe pain and limited mobility are indications for surgical intervention. All treatment strategies showed significant improvement. Greater improvement was observed in patients treated with hybrid stabilization than with isolated cementaugmentation, which may be important from a functional point of view.