A New Assessment System of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

Abstract Background We have developed a new scoring system that specifically designed for osteoporotic vertebral compression fractures (OVCFs) to guide treatment selection. This system evaluates four aspects: fracture type, fracture morphology, MRI signal changes, and bone mineral density. Methods From March 2016 to March 2021, we conducted a retrospective study of radiographic and clinical data from 208 patients who underwent conservative treatment for OVCFs. Based on the new assessment system of osteoporotic vertebral compression fractures (NASOVCF) scores, the patients were divided into low (48 cases), medium (108 cases), and high (52 cases) score groups. We compared the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, vertebral height loss, kyphosis angle, and bone union rate among the three groups. Logistic regression analysis was used to determine the relationship between bone non-union and independent variables. Results The low-score group showed significantly lower VAS and ODI scores both before treatment and at the follow-up compared to the medium-score and high-score groups (P < 0.05). Additionally, the low-score group had significantly lower vertebral height loss and kyphosis angle differences compared to the medium-score and high-score groups. The bone union rate in the low-score group was 97.9%, which was significantly higher than the rates of 75% in the medium-score group and 32.7% in the high-score group. The high-score group had a significantly higher risk of non-union compared to the low-score group (OR = 88.78; P = 0.001) and the medium-score group (OR = 15.67; P = 0.001). Additionally, female gender (OR = 3.20, P = 0.014), ODI at pre-treatment (OR = 1.11, P = 0.009), and NASOVCF score (OR = 2.59, P = 0.000) were identified as independent risk factors for bone non-union. Conclusions Based on the NASOVCF scoring system, the low-score group showed superior outcomes in terms of pain relief, functional improvement, prevention of vertebral height loss and worsening spinal kyphosis, as well as a higher bone union rate, compared to the medium-score and high-score groups. Therefore, conservative treatment is recommended for OVCF patients with a score of 3 or less, while surgical treatment is recommended for patients with a score of 7 or higher.