The commonly used treatment options for OVCFs include conservative treatment and vertebral augmentation procedures. Conservative treatment, which involves rest, activity restriction, pain management, physical and rehabilitation therapy, and anti-osteoporosis treatment, is the most frequently employed treatment[1]. A comprehensive evaluation of fracture patients is crucial for selecting the appropriate treatment plan. While the TLICS scoring system is commonly used for assessing thoracolumbar spine fractures, it primarily focuses on traumatic fractures and does not consider osteoporotic factors. Other classification systems, such as the Genant grading system, Magerl classification system, and AO classification system, primarily focus on fracture morphology[11]. Currently, there is a lack of a comprehensive and effective evaluation system specifically designed for OVCFs to guide treatment selection. In this study, we designed a new scoring system for OVCFs that evaluates fracture type, fracture morphology, MRI signal changes, and bone density. A retrospective study was conducted on 208 patients with OVCFs who underwent conservative treatment, and they were divided into low, medium, and high score groups based on the scoring system. The results of this study suggest that the low-score group exhibited significant improvements in pain, functional outcomes, further vertebral collapse, progressive spinal kyphosis, and bone healing rate compared to the medium and high-score groups. Therefore, conservative treatment is recommended for patients with a score of 3 or less, while surgical treatment is recommended for patients with a score of 7 or more.
Conservative treatment of OVCFs typically leads to a noticeable pain reduction and functional improvement after a 1-month follow-up. VAS commonly shows a pain improvement of around 40–50%, while the ODI reflects a functional improvement of approximately 30–50%[14]. In this study, all three groups showed significant enhancements in VAS and ODI scores following treatment. Moreover, the low-score group displayed significantly superior pre-treatment and follow-up VAS and ODI scores compared to the high-score and medium-score groups, with statistically significant differences. These results indicate that patients in the low-score group experienced more notable enhancements in pain relief and functional outcomes relative to the other groups.
According to the literature, conservative treatment of OVCFs may result in a further decrease in vertebral height by 10–20%, along with an increase in the local kyphotic angle by approximately 10 degrees[15]. In our study, the mean difference in vertebral height loss for the low-score group was 1.7 ± 2.9, and the difference in kyphosis angle was 1.6 ± 2.7, which was significantly lower compared to previous studies. Furthermore, the low-score group exhibited significantly lower vertebral height loss and kyphosis angle differences compared to the high-score and medium-score groups, indicating that patients in the low-score group had superior outcomes in terms of attenuate further vertebral height loss and progression of kyphotic deformity compared to the other two groups.
It has been reported that the incidence of non-union in conservative treatment of OVCFs generally ranges from 10–20%[1, 4]. In this study, the non-union rate in the low-score group was 2.1%, whereas in the high-score group, it was 67.3%. There was a significant statistical difference between the two groups, and the non-union rate in the high-score group was also significantly higher than the levels reported in previous literature. In addition, the high-score group had a significantly higher risk of non-union compared to the low-score group (OR = 88.78), as well as compared to the medium-score group (OR = 5.67). The occurrence of non-union in conservative treatment of OVCFs can be influenced by various factors, such as the patient's age, gender, severity of osteoporosis, fracture type, and severity. In this study, it was found that female gender, pre-treatment ODI score, and NASOVCF score were identified as high-risk factors for non-union. All the aforementioned data suggest that if the NASOVCF score for patients with OVCFs is greater than or equal to 7, they are at a relatively higher risk of non-union with conservative treatment. For these patients, surgical treatment is the preferred option. On the other hand, for patients with a NASOVCF score of less than or equal to 3, the risk of non-union is relatively low, and conservative treatment is an effective treatment option.
This study had some limitations. First, the sample size was relatively small, and randomized controlled studies with a larger sample size are needed to verify our results in the future. In addition, the follow-up time was relatively short (only 6 months), and future studies with longer follow-up periods will be used to verify the efficacy of the new scoring system.