Formula guides management of osteoporotic vertebral fractures

The decision-making process to select operative or nonoperative treatment of osteoporotic fractures differs widely among surgeons. However, according to a presenter at the EuroSpine Annual Meeting, a guideline members of the German Society for Orthopaedic and Trauma Surgery developed can help surgeons decide whether surgery is necessary for a particular patient.

According to Thomas R. Blattert, MD, of Schwarzach, Germany, the guidelines offer physicians a tool they can use to score a patient’s osteoporotic fracture. If the score is above six points, surgery is likely needed, and if the score is less than six points, then nonsurgical options should be pursued.

“For low grade fractures, for OF1 and OF2, a score usually lower than six means nonsurgical treatment is recommended. The therapeutic guidelines that we present provide a reliable and reproducible basis to decide for treatment choices,” Blattert said.

This study was selected as one of the “Best of Show” papers at the EuroSpine Annual Meeting.

Score determines treatment

Blattert and colleagues developed the guidelines after they evaluated 707 clinical cases of vertebral fractures among patients at 16 hospitals. The fractures were graded from OF1 to OF5, where an OF1 fracture means there is no deformity present after the injury and an OF5 fracture means there is an injury with the highest level of instability.

“If you end up with zero to five points, there is a clear suggestion of nonsurgical treatment. If you are over six points it is suggested you go with surgical management,” Blattert said.

The actual treatment chosen in the spine centers included in the study corresponded to the guideline score in 85% of cases, he said.

Individualized treatment necessary

The investigators used different patient parameters, such as bone mineral density, ongoing fracture process, pain scores, neurological deficits, mobilization and health status, to assign the “point score” to the osteoporotic vertebral fractures they studied.

According to Blattert, the primary goal of any treatment was stability over motion preservation. In addition, it was mandatory to restore the physiological loading capacity of the spine regardless of the treatment chosen. However, injuries with fractures in ankylosing spondylitis, neurological impairment that required fusion, multiple-level fractures and consecutive-level and adjacent-level fractures needed to be addressed separately, he noted.

If a patient’s fracture has a score of six points, the treatment must be based on the individual patient and other mitigating factors. Therefore, the treatment choice is ultimately left to the physician whenever the score comes in at six points, Blattert said.

If surgery is needed, it must account for any compromised bone quality. Furthermore, cement augmentation or high purchase screws are recommended for such a procedure, Blattert and colleagues noted in the study. – by Robert Linnehan

Reference:
Blattert TR, et al. Paper #80. Presented at: EuroSpine Annual Meeting; Sept. 2-4, 2015; Copenhagen, Denmark.

For more information:
Thomas R. Blattert, MD, can be reached at Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Dekan-Graf-Strasse 2-6, D-94374 Schwarzach, Germany; email: thomas.blattert@ofks.de.

Disclosure: Blattert reports he is a consultant for Aesculap, Medtronic and Spontech, and he receives other financial support from AOSpine.