Application Of OTLICS Scoring System In The Treatment Of Patients With Acute Symptomatic Osteoporotic Thoracolumbar Fractures

Part I.Treatment options for patients with type I acute symptomatic osteoporotic thoracolumbar fractures with an OTLICS score of 4Objective:To compare the clinical outcomes of patients with type I acute symptomatic osteoporotic thoracolumbar fractures（ASOTLF）with an OTLICS score of 4in surgical versus non-surgical treatment.Methods:The clinical data of 68 patients with type I ASOTLF admitted to the Honghui Hospital affiliated to Xi’an Jiaotong University from January 2019 to December2021 were retrospectively analyzed,including 26 males and 42 females.The age ranged from 60 to 92 years old[（75.82±7.54）years].Causes of injury:40 cases without obvious trauma,28 cases with more serious trauma.Injury segments:T₆ to T₁₀ in 16 cases,T₁₁ to L₂ in 38 cases,and L₃ to L₅ in 14 cases.Among them,38 cases were treated with PVP surgery（surgical group）and 30 cases were treated with non-surgical treatment（non-surgical group）at the same time in the outpatient clinic.The visual analog score（VAS）,Oswestry dysfunction index（ODI）,and Short Form-36（SF-36）before treatment,3 days,3 months,6 months,and at the last follow-up were compared between the two groups;the height of injured vertebral collapse,new vertebral fractures,and the occurrence of complications before and after treatment were compared between the two groups,and the clinical efficacy of the two groups was evaluated.Results:Patients were followed up for more than 12 months,and the differences between the general data of the two groups were not statistically significant and comparable（P>0.05）.The differences in VAS scores,ODI index and SF-36 scores between the two groups before treatment were not statistically significant（P>0.05）,and the improvements in VAS scores,ODI index and SF-36 scores in the operated group were better than those in the non-operated group at 3 days,3 months and 6 months after treatment（P<0.05）,and the differences were not statistically significant at the last follow-up（P>0.05）.There was no statistically significant difference in the height of injured spine collapse between the two groups before and 3 months after treatment（P>0.05）,but collapse of the injured spine was more pronounced in the non-operated group than in the operated group at 6 months after treatment and at the final follow-up（P<0.05）.The incidence of new vertebral fractures was 39.5%（15/38）in the surgical group and 60.0%（18/30）in the non-surgical group,with no statistically significant difference between the two groups（P>0.05）.However,the incidence of injured vertebral collapse was 36.7%（11/30）in the non-operative group was significantly higher than that of 13.2%（5/38）in the operative group（χ²=5.149,P<0.05）.The rate of bone cement leakage（BCL）was 26.3%（10/38）in the surgical group and 36.7%（11/30）in the non-surgical group for bed-related complications,with no statistically significant difference between the two groups（P>0.05）.The excellent clinical efficacy rate at the last follow-up was 78.9%（30/38）in the surgical group and 63.3%（19/30）in the non-surgical group,and the difference between the two groups was not statistically significant（P>0.05）.Conclusions:In patients with type I ASOTLF with an OTLICS score of 4,PVP was superior to non-operative procedures in terms of early pain relief,improved spinal function,and quality of life,but there was no significant difference in long-term clinical outcomes.the efficacy of PVP and non-operative procedures was comparable in terms of complications,but PVP was significantly better than non-operative procedures in preventing collapse of the injured spine.Part II Treatment options for patients with type II acute symptomatic osteoporotic thoracolumbar fractures with an OTLICS score of 4Objective:To compare the clinical outcomes of patients with type II acute symptomatic osteoporotic thoracolumbar fractures（ASOTLF）with an OTLICS score of 4in surgical versus non-surgical treatment.Methods:The clinical data of 128 patients with type II ASOTLF admitted to the Honghui Hospital affiliated to Xi’an Jiaotong University from January 2019 to December2021 were retrospectively analyzed,with 43 males and 85 females.The age ranged from60 to 88 years old[（75.60±10.83）years].Causes of injury:38 cases of sprains,69 cases of falls,and 21 cases of other causes.Type of fracture:76 cases of type IIA,30 cases of type IIB,and 22 cases of type IIC.Injured segments:T₆ to T₁₀ in 25 cases,T₁₁ to L₂ in 84 cases,and L₃ to L₅ in 19 cases.Among them,76 cases were treated surgically with PVP（surgical group）and 52 cases were treated non-surgically at the same time in the outpatient clinic（non-surgical group）.The visual analog score（VAS）,Oswestry dysfunction index（ODI）,and Short Form-36（SF-36）were compared before,3 days,3 months,6 months after treatment,and at the final follow-up between the two groups;the posterior convex Cobb angle and anterior margin height ratio of the injured spine,new vertebral fractures,and the occurrence of complications were compared between the two groups before and after treatment,and survival analysis was used to study the relationship between time and the relationship between pain relief.Results:Patients were followed up for more than 12 months of follow-up,and the differences between the general data of the two groups were not statistically significant and comparable（P>0.05）.The differences in VAS score,ODI index and SF-36 score between the two groups before treatment were not statistically significant（P>0.05）,and the improvements in VAS score,ODI index and SF-36 score in the operated group were better than those in the non-operated group at 3 days,3 months and 6 months after treatment（P<0.05）,and the differences at the last follow-up were not statistically significant（P>0.05）.The differences in the posterior convex Cobb angle and the height ratio of the anterior edge of the injured vertebrae between the two groups before treatment were not statistically significant（P>0.05）,and the improvement in the posterior convex Cobb angle and height of the injured vertebrae in the operated group was better than that in the non-operated group at all time points after treatment（P<0.05）.The incidence of new vertebral fractures was 31.6%（24/76）in the surgical group and 28.8%（15/52）in the non-surgical group,and the difference between the two groups was not statistically significant（P>0.05）.The rate of bone cement leakage（BCL）was 23.7%（18/76）in the surgical group and the incidence of bed rest-related complications was 26.9%（14/52）in the non-surgical group,with no statistically significant difference between the two groups（P>0.05）.The significant pain relief rate of 92.1%（70/76）in the operated group was significantly better than that of 34.6%（18/52）in the non-operated group 1 month after treatment（χ²=47.497,P<0.05）.Conclusions:For patients with type II ASOTLF with an OTLICS score of 4,surgery should be performed promptly,which can rapidly relieve the pain symptoms caused by vertebral fracture in a short period of time,effectively improve the posterior convexity Cobb angle of the injured vertebra and restore the height of the injured vertebra,thus promoting the recovery of spinal function as well as improving the quality of life of patients.