Artikel
Clinical treatment outcomes and complications of osteoporotic thoracolumbarfracturesafter conservative or surgical treatment – initial data from the prospective, multi-centre study evaluating the OF classification, OF-score and therapy recommendations for osteoporotic vertebral fractures (EOFTT)
Klinische Ergebnisse nach konservativer oder operativer Behandlung osteoporotischer thorakolumbaler Frakturen – erste Daten aus der prospektiven, multizentrischen Studie zur Evaluierung von OF-Klassifikation, OF-Score und Therapieempfehlungen für osteoporotische Wirbelfrakturen (EOFTT)
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Osteoporotic fractures of the spine are a rising health issue.The research group ‘Osteoporotic fractures’ ofthe spine section of the German Society for Orthopaedics and Trauma (AG-OF) has initiated a prospective, multicentre study evaluating the OF classification, OF-score and therapy recommendation for osteoporotic vertebral fractures (EOFTT).
The OF-score takes account of fracture classification, bone density, sintering dynamics, pain, neurology, mobilization and health status and separates between recommendation on surgical or conservative therapy. This sub-study examines the therapy and its influence on the score and the complication rate.
Methods: Complications that required revision were gathered as well as the OF-score at following date set: day of treatment decision (dtd), discharge and 6 week follow up (FU). A change in the score was evaluated by repeated measures of ANOVA at 3 points in time. To examine the effects of the therapy (surgical/conservative) on the score, repetitive measurements via ANCOVA were carried out. At the same time the scores were taken into consideration as a baseline (covariant) at the time of treatment decision.
Results: 101 surgically and 73 conservatively treated patients (39♂, 135♀), with a mean age of 73±9 years (50-94) could be acquired from the data. Figure 1 [Fig. 1] illustrates the distribution of the OF-score at dtd. Figure 2 [Fig. 2] shows the distribution at discharge. ANOVA shows a reduction of the OF-score (p<0.001). ANCOVA shows a sig. influence of baseline (p<0.001) and therapy (p=0.031).
Surgically treated patients have a sig. greater reduction of the OF-score than conservatively treated patients. 4 patients had complications that required revision at the time of discharge. At the time of FU 2 of 38 OF 4 (5%) patients showed complications that required revision (implant-assoc.). Moreover, 4 of 73 FU patients (5%) had to switch from conservative to surgical treatment.
Conclusion: With an improved score over time, surgically treated patients appear to benefit from a reduction in the OF-score. Therefore, the application of the OF-score seems to be prognostically beneficial. In terms of complications that required revision, attention must be given to the OF classifications 4 and 5, even if the overall complication rate is like in bone healthy patients.