INTRODUCTION
The German Society for Orthopaedics and Trauma (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie) (DGOU) has developed an osteoporotic fracture (OF) classification for osteoporotic thoracolumbar vertebral fractures. This classification is divided into types based on the presence or absence of endplate injury, as well as posterior wall damage. The greater the damage to the endplates and posterior wall, the greater the degree of severity. Consequently, the indication for surgery increases. However, we have encountered cases of bilateral endplate injuries without neurological symptoms in which surgery was not indicated. Furthermore, cases of unilateral endplate injuries have occurred with the presentation of neurological symptoms or that required surgery. We aimed to investigate the correlation of the OF classification with the presence of neurological symptoms and positive indication for surgical intervention for OFs of the lower lumbar (L3–5) vertebrae.
METHODS
In this study, we included 32 participants who had been hospitalized for osteoporotic vertebral fractures of the L3–5 vertebrae, between April 2019 and September 2023. Participants with a history of lumbar spinal fusion or diffuse idiopathic skeletal hyperostosis were excluded. The OF classification, presence of lower limb neurological symptoms, and requirement for surgical intervention were included in the data analysis. Moreover, OF 2 and 3 that involved unilateral endplate injuries were further classified according to whether the endplate had been injured cranially or caudally. OF 4 that involved bilateral endplate injuries was further classified based on the presence or absence of posterior wall damage.
RESULTS
There were eight male and 24 female participants, with a mean age of 80.5 ± 8.0 years old. Four participants had an OF 1. Nineteen participants had an OF 2, of which 14 and five had the cranial and caudal subtypes, respectively. All four participants with an OF 3 had the cranial subtype. Five participants had an OF 4, of which four had posterior wall damage and one did not. None of the participants had an OF 5. Six participants required surgical intervention, of which five had either an OF 3 with neurological symptoms or OF 4 with posterior wall damage. Only one participant with an OF 2 caudal subtype underwent surgery for lower back pain. Fourteen participants had neurological symptoms, of which four had an OF 4 with posterior wall damage, four had an OF 3, and the remaining participants had an OF 2. Four of the six cases that had spinal canal stenosis at the same site were of the caudal subtype, while only two cases were of the cranial subtype. All participants with an OF 2 who presented with neurological symptoms were treated conservatively, and symptoms improved with bone union.
DISCUSSION
OF 3 and 4 that involved posterior wall damage frequently required surgical intervention. The OF 2 caudal subtype commonly presented with neurological symptoms; however, surgical intervention was rarely required. Thus, unstable posterior wall damage may not present with neurological symptoms. Furthermore, in cases of stable fractures, the caudal subtypes were associated with neurological symptoms that originated from the intervertebral foramen.