One-year mortality and functional outcome of inpatients aged 85 and older with thoracolumbar vertebral fractures: differences between operative and conservative treatment

The evidence for operative treatment (OP) versus conservative management (CM) in patients with vertebral fractures (VFs) remains controversial. The aim of this study was to evaluate the impact of treatment on clinical outcomes.

All patients aged ≥ 85 years presenting with a symptomatic thoracolumbar VF (either acute or exacerbated chronic) at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were all-cause mortality and its associated factors one year after hospital admission, as well as disability and quality of life (QoL), measured by the Oswestry Disability Index (ODI). For statistical analysis, the Kaplan-Meier method and Cox proportional hazards modeling were performed.

A total of 153 patients (mean age 88.5, range 85 to 99; 68.6% female) were included. Fifty-nine of those (38.6%) had OP. All-cause mortality within one year after hospital admission was 34.9%, with 27.1% in the OP group and 39.4% in the CM group (p = 0.248). Survival probabilities at 1-, 3-, 6-, and 12-month follow-up were 86.9%, 80.3%, 69.1%, and 65.1%, respectively. Factors associated with a higher mortality risk included greater comorbidity severity (p < 0.001) and hospital complications (p < 0.001). In the follow-up survey, the mean ODI score was 40.3%, with 41.3% in the OP group and 38.9% in the CM group (p = 0.739). The average Visual Analog Scale (VAS) score was 3.0 (p = 0.755).

In the oldest-old, VFs represent a severe event with a substantial risk of poor survival and functional outcomes after one year. Patient comorbidities and complications during the initial hospital stay outweigh the role of treatment strategy. Definitive treatment recommendations for OP and CM remain difficult and should be individualized whenever possible. With an aging population and the increasing relevance of VFs in clinical practice, further research is warranted.