Classification of vertebral compression fractures in the osteoporotic spine

Objective: The purpose of this study was to clarify the relationship between initial radiographs of osteoporotic vertebral compression fractures (VCFs) and clinical results. Methods: Of the 135 VCFs in the elderly, 73 consecutive patients (84 vertebrae) were reviewed retrospectively. All patients were treated without rigid immobilization. The subjects consisted of 15 men and 58 women. The mean age was 75.0 years with a range from 61 to 91 years. The early radiographic features were classified into five types based on lateral radiographs. Radiographic results during follow-up were evaluated according to the number of collapsed vertebrae and vacuum clefts. Clinical results were evaluated by Visual Analog Scale and activities of daily living. Results: Of the five types, swelled-front-type, bow-shaped-type, and projecting-type fractures had a poor prognosis with late collapse and often showing a vacuum cleft. On the other hand, concave-type and dented-type fractures had a good prognosis and almost achieved fusion. Clinical results of 28 patients with vacuum clefts were fair at the final follow-up. Nineteen patients had little back pain, and nine patients experienced moderate back pain. Regarding the activities of daily living, four patients had difficulty walking.