Stellenwert der operativen Behandlung thorakolumbaler Wirbelkörperfrakturen für die Überlebenswahrscheinlichkeit alterstraumatologischer Patienten

BACKGROUND: Osteoporotic vertebral compression fractures (VCF) are a common injury among older patients. The optimal treatment option (operative or conservative) is still discussed. The literature describes a reduced mortality following operative augmentation of VCF compared to conservative treatment. We examined our orthogeriatric patient cohort to find out whether there is a positive correlation between surgical treatment of VCF and the survival rate. METHODS: We performed an assessment of all patients with an osteoporotic spinal fracture who were treated on an orthogeriatric care unit due to VCF between 1 February 2014 and 31 January 2015. The treatment associated-mortality was examined in a 2-year follow-up, with a special focus on the influence of the treatment. RESULTS: A total of 74 patients (74% follow-up) with an average age of 83.2 years were included, 40 having been treated conservatively and 34 surgically. Overall, the 1‑year and 2‑year mortalities were 29.7% and 35.1%, respectively. Surgical treatment was associated with 1‑year and 2‑year mortalities of 20.6% and 23.5% compared to 37.5% and 45%, respectively, after conservative treatment (p = 0.113 and 0.086, χ(2)-test). The adjusted hazard ratio was 2.0 (95% confidence interval, CI 0.686–6.100). DISCUSSION: Although no statistically significant difference between the treatment groups could be detected (possibly due to the small sample size), the analysis showed a tendency towards an improved survival after surgical treatment. This is in accordance with international studies. Further investigations in the literature suggest that the reduction of kyphosis by surgery could represent an important causal association.