• Bernhard W Ullrich, Philipp Schenk, Max J Scheyerer, Martin Bäumlein, Sebastian Katscher, Klaus J Schnake, Volker Zimmermann, Falko Schwarz, Gregor Schmeiser, Michael Scherer, Michael Müller, Kai Sprengel, Georg Osterhoff, Katja Liepold, Simon Schramm, Christopher Baron, Holger Siekmann, Alexander Franck, N Isik, Friederike Klauke, Ulrich J A Spiegl, and Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma.
• Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany. b.w.ullrich@me.com.
• Eur Spine J. 2023 May 1; 32 (5): 152515351525-1535.

AimOsteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed.PurposePatients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed.MethodsA total of 518 patients' aged 75 ± 10 (41-97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness.ResultsFive (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients.ConclusionFracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.© 2023. The Author(s).

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