gms | German Medical Science

Objectives: Minimal invasive hybrid stabilization (MIHS) is a safe treatment alternative for dorso-ventral interventions in patients with unstable osteoporotic fractures (OF) of the spine. Minimal invasive interventions are associated with less post-operative pain and complication. MIHS allows for early mobilization and prompt hospital discharge. Long-term outcome including non-trauma mortality is relatively unclear. The current study aimed to determine post-operative survival and to identify predictive factors for mortality in osteoporotic patients.

Methods: Adult patients treated in a level one spine center by MIHS for unstable osteoporotic fractures of the lumbar and thoracic spine have been included. Trauma and patient characteristics as well as 2-year outcome have been analyzed. To identify factors that are associated with post-traumatic mortality we grouped and compared patients who SURVived the follow-up period and those patients who did not survive (MORTality-group

Result: A total of 75 patients with a mean age of 76 have been included of whom 72% were females. 49 patients were diagnosed with unstable OF 3 fractures, whereas 26 patients had OF 4 fractures. Mean duration of hospital stay was 13 (std: 7) days. 18.7 percent of patients had a complicated course. No in-hospital mortality occurred. During the 2-yr follow-up, a total of 19 fatalities occurred at a mean age of 82 (std: 6) years. Thereby, the 2-yr post-operative survival rate is 75%. In the MORT-group, the percentage of OF 4 fractures was lower than in the SURV-group (10.5 vs. 75.0%, p<0.01). Furthermore, overall operating time was longer in the MORT-group than in the SURV-group (p=0.04). Patients from the MORT-group had more frequently complicated in-hospital courses than those patients from the SURV-group (37.0% vs. 12.5%, p=0.04).

Minimal-invasive hybrid stabilization is a safe and feasible treatment option for unstable osteoporotic spine fractures. However, 2-year survival rates of 75% demonstrate that unstable spinal osteoporotic fractures are linked with significant impaired life expectancy. Patient specific characteristics do not affect post-discharge survival, however fracture type (OF 3, rather than OF 4), prolonged operating time and post-operative complications are associated with post-discharge mortality. To optimize treatment guidelines (and selection criteria for operative treatment modalities) for frail patients with unstable spinal fractures, more prospective multicenter studies are indicated.