J Korean Soc Geriatr Neurosurg > Volume 16(1); 2020 > Article
Journal of Korean Society of Geriatric Neurosurgery 2020;16(1):28-36.
DOI: https://doi.org/10.51638/jksgn.20.00199    Published online September 30, 2020.
Osteoporotic/Osteopenic Non-operative Thoracolumbar Burst Fracture: Radiologic and Clinical Analyses in View of Bone Mineral Density and the OF Classification
Jeong Su Han, Se-Hoon Kim, Sung-Kon Ha, Sang-Dae Kim, Dong-Jun Lim, Bum-Joon Kim
Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
Correspondence:  Bum-Joon Kim, Tel: +82-31-412-5053, Fax: +82-31-412-5054, 
Email: nsbjkim@korea.ac.kr
Abstract
Objective
We analyzed the radiologic and clinical outcomes of thoracolumbar burst fractures to elucidate the relationship between bone mineral density, the Osteoporotic Fracture (OF) classification, and outcomes of conservative treatment. It is expected that severe osteoporosis would have unfavorable outcomes after conservative treatment in stable burst fractures; however, precise data are unavailable.
Methods
From January 2009 to May 2017, patients older than 50 years with thoracolumbar burst fractures and who were conservatively treated were included. Radiologic parameters were collected from radiographs and MRI scans at baseline and the 2-year follow-up.
Results
52 patients (11 men and 41 women) were included. The most frequent location of fracture was L1 (46.2%); slip down (57.7%) was the most common mechanism of traumatic injury. According to the OF classification system, all patients were classified as OF 3 or above; there were 21 patients classified as OF3, 29 as OF4, and 2 as OF5. BMD and the OF score showed a strong correlation with the radiologic parameters of delayed vertebral collapse. On final radiographs, a lower T-score and higher OF score indicated a higher compression rate. Conversely, the final visual analog scale was not different between patients with a high T-score and those with a low T-score, as well as between the OF3 and OF4 groups.
Conclusion
Many osteoporotic fractures can be treated conservatively even in patients with an OF score of 4. Radiologically, a low BMD and higher OF score are related to initial and delayed vertebral collapses.
Key Words: Bone mineral density, Spinal compression fractures, Osteoporosis, Thoracolumbar vertebra, Metabolic bone diseases
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