Are ◯% of vertebral fracture patients experiencing sagittal alignment abnormalities?

📖 Literature Information and Abstract Translation

Osteoporotic vertebral fractures localized in the lumbar area significantly impact sagittal alignment

[Background/Objective] Lumbar fractures and/or multiple fractures in the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in elderly patients over 70 years old. Patients with OVF (Osteoporotic vertebral fractures) show significant compensatory capacity after fractures, but lumbar and thoracolumbar fractures require closer monitoring. Objective: To evaluate the impact of osteoporotic vertebral fractures on sagittal alignment in the elderly and to identify risk factors for sagittal alignment abnormalities.

[Methods] A retrospective study was conducted on a cohort of 249 patients aged 70 or older diagnosed with osteoporosis who had chronic vertebral fractures. Demographic and radiographic data were collected. Full-spine lateral radiographs were obtained to analyze the sagittal plane. Patients were classified according to the number and location of fractures. Pearson correlation coefficients were used to evaluate the relationship between fracture type and sagittal alignment.

[Results] A total of 673 chronic fractures were detected in 249 patients, with an average of 2.7±1.9 vertebral fractures per person. 41 individuals (16%) had sagittal alignment abnormalities.

In the group showing sagittal alignment abnormalities, an excess of patients with lumbar fractures (34% vs 11%) and a deficit of thoracic fractures (9% vs 34%) were reported. It was also observed that patients with 3 or more lumbar or thoracolumbar fractures have a higher risk of sagittal alignment abnormalities.

[Conclusion] Lumbar fractures and/or multiple fractures in the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in elderly patients over 70 years old. Although patients show significant compensatory capacity, fractures in the lumbar and thoracolumbar regions require closer monitoring.

🌱 So What?: What did I find interesting?

This is something I often experience in conversations with patients who have vertebral fractures.
Theoretically, one might think, "That makes sense," and I have answered that way every time.
This literature review is a study that actually verified that.

According to it, it was "16%" of vertebral fracture patients.
Whether this 16% is high or low, I don't know.
However, it is a fact that approximately 1 in 6 people show sagittal alignment abnormalities.
What concerns me in this study is "What was it like before the disease?".
There is a possibility that they already showed postural alignment abnormalities before the disease.
Thinking about it that way, the number of people who purely crossed the threshold of abnormality due to the fracture might be less than 16%.
In any case, I felt that interventions to minimize sagittal alignment abnormalities after vertebral fractures are indeed necessary.

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