Risk Factors for the Progressive Osteoporotic Spinal Fracture / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: Retrospective risk-factor analysis OBJECTIVES: This study investigated the clinical and radiological risk factors associated with the progression of osteoporotic spinal fractures (OSFs) after conservative treatment. SUMMARY OF THE LITERATURE REVIEW: Nonunion and cleft signs on radiographs are strongly associated with complicated osteoporotic spinal fractures. MATERIALS AND METHODS: From Jan. 2005 to Dec. 2007, 84 patients (15 males and 69 females; mean 72.6 yrs) were enrolled in this retrospective review. The progressive OSF, clinical and radiological factors were analyzed considering the progression of the kyphotic angle (PKA>20degrees) and the presence of intravertebral cleft signs (IVC). Age, gender, body mass index, vertebral level involved, BMD score, MRI classification and initial kyphotic angle were adopted for the analysis. For statistical analysis, a chi-square test was performed to analyze the relationship between each factor and multiple logistic regression analysis was performed to analyze the multifactorial explanatory factor. RESULTS: The presence of IVC was related to the thoracolumbar fracture, mid-portion MR classification and high body mass index. PKA>20degrees was related to the thoracolumbar fracture and mid-portion classification. For multifactorial analysis using these seven factors, two factors (the level of fracture and MR classification) were found to be associated with the presence of IVC with statistical significance. In the thoracolumbar fracture, the incidence of IVC was 5.2 times higher than the other levels. The incidence of IVC in endplate classification was 16% lower than in the mid-portion. CONCLUSION: BMI, the fracture level involved and MR classification were associated with the development of IVC and PKA>20degrees for a conservative treatment of OSF. Multiple logistic analysis revealed the level of the fracture and MR classification to be significant.