High-Risk Osteoporotic Vertebral Fractures for Pseudarthrosis Causing Painful Elderly Kyphosis

PURPOSE: To determine high-risk fractures for osteoporotic vertebral pseudarthrosis (OVP) causing painful elderly kyphosis with/without neurological compromise.

METHODS: Conservatively treated 101 patients with osteoporotic vertebral fractures were followed a minimum of 2 years. Criteria for OVP were intravertebral vacuum cleft, intravertebral instability on flexion-extension X-rays, and progressive kyphosis. Risk factor analysis for OVP was conducted using multivariate logistic regression model.

RESULTS: Incidence of OVP was 13.9%. High-risk fractures for OVP were determined as follows: those caused by extremely minor injury events such as twisting the trunk or lifting heavy objects (odds ratio [OR]: 26.7, p=0.010); those in more aged population (OR/10 years: 12.0, p=0.012); and those with middle-column involvement (OR: 9.7, p=0.038). The other factors such as severity of initial injuries were proved to be insignificant.

CONCLUSIONS: Determination of high-risk fracture for OVP allows us to select optimum initial treatment for osteoporotic vertebral fractures such as kyphoplasty to prevent OVP.