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  • 1
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    Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization
    SAGE Publications ; 2023
    In:  Global Spine Journal Vol. 13, No. 1_suppl ( 2023-04), p. 6S-12S
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 1_suppl ( 2023-04), p. 6S-12S
    Kurzfassung: Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with poor clinical results. Methods We carried out a comprehensive, systematic literature search according to the PRISMA checklist and algorithm. Risk factors for perioperative complications, for early inpatient readmission, for the duration of the hospital stay, the hospital mortality, the total mortality and the clinical result were analyzed. Results A total of 739 potentially usable studies were identified. After considering all inclusion and exclusion criteria, 15 studies with 15,515 patients were included. Non-adjustable risk factors were age 〉 90 years (OR 3.27), male gender (OR 1.41), BMI less than 18.5 kg/m 2 (OR 3.97), ASA score 〉 3 (OR 2.7), activity of daily live (ADL) (OR 1.52), dependence (OR 5.68), inpatient admission status (OR 3.22), Parkinson disease (OR 3.63) and disseminated cancer (OR 2.98). Adjustable factors were insufficient kidney function (GFR 〈 60 mL/min, and Creatinine Clearance below 60 mg/dl) (OR 4.4), nutrition status (hypalbuminemia ( 〈 3.5 g/dl)), liver function (OR 8.9) and further cardiac and pulmonary comorbidities. Discussion We identified a couple of non-adjustable risk factors, which should be considered preoperatively in terms of risk assessment. However, even more important were adjustable factors that can be influenced preoperatively. In conclusion, we recommend a perioperative interdisciplinary cooperation, especially with geriatricians, to achieve the best possible clinical results in geriatric patients undergoing surgery for OVCF.
    Materialart: Online-Ressource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221130050
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2023
    ZDB Id: 2648287-3
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  • 2
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    Concomitant injuries in patients with thoracic vertebral body fractures—a systematic literature review
    Springer Science and Business Media LLC ; 2022
    In:  Archives of Orthopaedic and Trauma Surgery Vol. 142, No. 7 ( 2022-07), p. 1483-1490
    Details
    In: Archives of Orthopaedic and Trauma Surgery, Springer Science and Business Media LLC, Vol. 142, No. 7 ( 2022-07), p. 1483-1490
    Kurzfassung: The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic vertebral body fractures . Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to November 2020 dealing with unstable fractures of the mid-thoracic spine. Results Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low. Conclusion The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.
    Materialart: Online-Ressource
    ISSN: 1434-3916
    URL: Article
    DOI: 10.1007/s00402-021-03830-2
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2022
    ZDB Id: 1458452-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review
    SAGE Publications ; 2022
    In:  Global Spine Journal Vol. 12, No. 2 ( 2022-03), p. 289-297
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 12, No. 2 ( 2022-03), p. 289-297
    Kurzfassung: Systematic review. Objectives: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. Methods: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. Results: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age 〉 73 years, bone mineral density with a t-score 〈 −2.95, BMI 〉 23 and a modified frailty index 〉 2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. Conclusion: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.
    Materialart: Online-Ressource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568220982279
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    ZDB Id: 2648287-3
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  • 4
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    Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review
    Springer Science and Business Media LLC ; 2021
    In:  European Journal of Trauma and Emergency Surgery Vol. 47, No. 5 ( 2021-10), p. 1389-1398
    Details
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 47, No. 5 ( 2021-10), p. 1389-1398
    Kurzfassung: The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.
    Materialart: Online-Ressource
    ISSN: 1863-9933 , 1863-9941
    URL: Article
    DOI: 10.1007/s00068-020-01560-5
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2021
    ZDB Id: 2276432-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures—results of the EOFTT study
    Springer Science and Business Media LLC ; 2023
    In:  European Spine Journal Vol. 32, No. 5 ( 2023-05), p. 1525-1535
    Details
    In: European Spine Journal, Springer Science and Business Media LLC, Vol. 32, No. 5 ( 2023-05), p. 1525-1535
    Kurzfassung: Osteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed. Purpose Patients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed. Methods A total of 518 patients’ aged 75 ± 10 (41–97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness. Results Five (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups ( p   〈  0.001). Over the course of treatment, mobility improved significantly ( p  = 0.001), with a significantly stronger ( p  = 0.007) improvement in the surgically treated patients. Conclusion Fracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.
    Materialart: Online-Ressource
    ISSN: 0940-6719 , 1432-0932
    URL: Article
    DOI: 10.1007/s00586-022-07519-x
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 1472721-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study
    SAGE Publications ; 2023
    In:  Global Spine Journal Vol. 13, No. 1_suppl ( 2023-04), p. 36S-43S
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 1_suppl ( 2023-04), p. 36S-43S
    Kurzfassung: Multicenter prospective cohort study Objective To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome. Methods A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6 weeks. Results A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76 years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131 days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups ( P 〈 .001) and had significant better TuG compared to hybrid stabilization ( P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P 〉 .602, Barthel: P 〉 .252, EQ-5D 5L index value: P 〉 .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits. Conclusions Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.
    Materialart: Online-Ressource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221140831
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2023
    ZDB Id: 2648287-3
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  • 7
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    Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients
    Georg Thieme Verlag KG ; 2020
    In:  Zeitschrift für Orthopädie und Unfallchirurgie Vol. 158, No. 06 ( 2020-12), p. 647-656
    Details
    In: Zeitschrift für Orthopädie und Unfallchirurgie, Georg Thieme Verlag KG, Vol. 158, No. 06 ( 2020-12), p. 647-656
    Kurzfassung: Hintergrund Frakturen des Dens axis beim geriatrischen Patienten stellen eine wachsende Entität mit hoher Morbidität und Mortalität dar. Die optimale Diagnostik und Behandlung der Verletzung in diesem Patientenkollektiv werden in der Literatur kontrovers diskutiert. Methodik In einem gemeinsamen Konsensusprozess erstellten die Mitglieder der Arbeitsgemeinschaft „Osteoporotische Frakturen“ und der Arbeitsgemeinschaft „Obere Halswirbelsäule“ der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) unter Berücksichtigung aktueller Literatur Empfehlungen zu Diagnostik und Behandlung von Frakturen des Dens axis bei geriatrischen Patienten. Ergebnisse In der Diagnostik der Densfrakturen stellt beim symptomatischen Patienten neben der konventionellen Bildgebung die Computertomografie den Goldstandard dar. Kernspintomografie und Funktionsaufnahmen können ergänzende Informationen liefern. Zur Klassifikation haben sich die Systeme nach Anderson/DʼAlonzo und Eysel/Roosen bewährt. Anhand der genannten Klassifikationen wurde ein Behandlungsalgorithmus entwickelt: Anderson/DʼAlonzo Typ 1, Typ 3 und nicht dislozierte Frakturen vom Typ 2 können i. d. R. unter engmaschigen Verlaufskontrollen konservativ behandelt werden. Bei Frakturen vom Typ 2 nach Anderson/DʼAlonzo bietet die operative Behandlung den Vorteil höherer knöcherner Heilungsraten. Dislozierte Typ-2- und Typ-3-Frakturen sollten operativ stabilisiert werden. Bei geeignetem Frakturverlauf (Eysel/Roosen 2A/B) sind anteriore Verfahren möglich. Posteriore Verfahren zur C I/II-Stabilisation sind etabliert und bei allen Frakturtypen durchführbar.
    Materialart: Online-Ressource
    ISSN: 1864-6697 , 1864-6743
    URL: Article
    DOI: 10.1055/a-0989-2791
    Sprache: Englisch
    Verlag: Georg Thieme Verlag KG
    Publikationsdatum: 2020
    ZDB Id: 2280747-0
    ZDB Id: 2304338-6
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  • 8
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    Clinical Evaluation of the Osteoporotic Fracture Treatment Score (OF-Score): Results of the Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations (EOFTT) Study
    SAGE Publications ; 2023
    In:  Global Spine Journal Vol. 13, No. 1_suppl ( 2023-04), p. 29S-35S
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 1_suppl ( 2023-04), p. 29S-35S
    Kurzfassung: Multicenter prospective cohort study. Objective The study aims to validate the recently developed OF score for treatment decisions in patients with osteoporotic vertebral compression fractures (OVCF). Methods This is a prospective multicenter cohort study (EOFTT) in 17 spine centers. All consecutive patients with OVCF were included. The decision for conservative or surgical therapy was made by the treating physician independent of the OF score recommendation. Final decisions were compared to the recommendations given by the OF score. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5 L, and Barthel Index. Results In total, 518 patients (75.3% female, age 75 ± 10) years were included. 344 (66%) patients received surgical treatment. 71% of patients were treated following the score recommendations. For an OF score cut-off value of 6.5, the sensitivity and specificity to predict actual treatment were 60% and 68% (AUC .684, P 〈 .001). During hospitalization overall 76 (14.7%) complications occurred. The mean follow-up rate and time were 92% and 5 ± 3.5 months, respectively. While all patients in the study cohort improved in clinical outcome parameters, the effect size was significantly less in the patients not treated in line with the OF score’s recommendation. Eight (3%) patients needed revision surgery. Conclusions Patients treated according to the OF score’s recommendations showed favorable short-term clinical results. Noncompliance with the score resulted in more pain and impaired functional outcome and quality of life. The OF score is a reliable and save tool to aid treatment decision in OVCF.
    Materialart: Online-Ressource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221148133
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2023
    ZDB Id: 2648287-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Fractures With Anterior or Posterior Tension Band Failure (OF 5): Short-Term Results From the Prospective EOFTT Multicenter Study
    SAGE Publications ; 2023
    In:  Global Spine Journal Vol. 13, No. 1_suppl ( 2023-04), p. 44S-51S
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 1_suppl ( 2023-04), p. 44S-51S
    Kurzfassung: Subgroup analysis of a multicenter prospective cohort study Objective To analyse surgical strategies applied to osteoporotic thoracolumbar osteoporotic fracture (OF) 5 injuries with anterior or posterior tension band failure and to assess related complications and clinical outcome. Methods A multicenter prospective cohort study (EOFTT) was conducted at 17 spine centers including 518 consecutive patients who were treated for an osteoporotic vertebral fracture (OVF). For the present study, only patients with OF 5 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale (VAS), Oswestry Disability Questionnaire (ODI), Timed Up & Go test (TUG), EQ-5D 5L, and Barthel Index. Results In total, 19 patients (78 ± 7 years, 13 female) were analysed. Operative treatment consisted of long-segment posterior instrumentation in 9 cases and short-segment posterior instrumentation in 10 cases. Pedicle screws were augmented in 68 %, augmentation of the fractured vertebra was performed in 42%, and additional anterior reconstruction was done in 21 %. Two patients (11 %) received short-segment posterior instrumentation without either anterior reconstruction or cement-augmentation of the fractured vertebra. No surgical or major complications occurred, but general postoperative complications were observed in 45%. At a follow-up of mean 20 ± 10 weeks (range, 12 to 48 weeks), patients showed significant improvements in all functional outcome parameters. Conclusions In this analysis of patients with type OF 5 fractures, surgical stabilization was the treatment of choice and lead to significant short-term improvement in terms of functional outcome and quality of life despite a high general complication rate.
    Materialart: Online-Ressource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221127956
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2023
    ZDB Id: 2648287-3
    Standort Signatur Einschränkungen Verfügbarkeit
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