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  • 1
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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
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0940-6719 , 1432-0932
    URL: Article
    DOI: 10.1007/s00586-022-07519-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1472721-3
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  • 2
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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
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    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 1_suppl ( 2023-04), p. 36S-43S
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221140831
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2648287-3
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  • 3
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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
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 1864-6697 , 1864-6743
    URL: Article
    DOI: 10.1055/a-0989-2791
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2280747-0
    detail.hit.zdb_id: 2304338-6
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  • 4
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    Online Resource
    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
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221148133
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2648287-3
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  • 5
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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
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/21925682221127956
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2648287-3
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  • 6
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    OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures
    Springer Science and Business Media LLC ; 2021
    In:  BMC Musculoskeletal Disorders Vol. 22, No. 1 ( 2021-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2021-12)
    Abstract: Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss’ kappa (κ F ) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall’s tau (τ K ). The presence of a modifier was calculated with κ F for interRR and Cohen’s kappa (κ C ) for intraRR. Results The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κ F  = 0.764 (Survey 1) and κ F  = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κ F Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κ F min.–max. Survey 1/Survey 2: 0.708–0.827/0.747–0.852). The existence of at least one modifier was rated with substantial agreement (κ F Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τ K  = 0.894, DR: τ K  = 0.901, UR: τ K  = 0.889). The modifier had an intraRR of κ C  = 0.684 (DR: κ C  = 0.723, UR: κ C  = 0.651), which is also considered substantial. Conclusion The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-021-04882-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2041355-5
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