Failure of Conservatively Managed Traumatic Vertebral Compression Fractures: A Systematic Review

Most vertebral compression fractures (VCFs) are successfully managed conservatively, however, some patients fail conservative management and require further surgical treatment. Here, we identify significant variables that contribute to progressive vertebral collapse in non-operative treatment of traumatic VCFs. A systematic review using PRISMA guidelines identified original research articles of conservatively managed VCF secondary to trauma from inception to September 2021. Articles with patients treated with initial non-operative therapy, AO-Type A0/A1/A2 fractures, risk factor analysis, >10 patients, and vertebral fracture secondary to trauma were included. Articles including pediatric patients, burst fractures or AO-Type A3/A4 fractures, vertebral fractures secondary to neoplasm or infectious disease, and operative versus non-operative treatment comparative studies were excluded. Failure of non-operative treatment was defined as salvage surgery/vertebral augmentation, progressive kyphosis, chronic pain, or functional disability. 3,877 articles were identified, and six articles were included. 582 patients had conservatively managed thoracolumbar VCFs. 102 patients had reported treatment failure (17.5%). Of the 102 treatment failures, 37 (36.3%) were due to subsequent VCF, 33 (32.4%) to back pain or functional disability at follow-up, and 32 (31.4%) were to increased compression rate or kyphotic deformity at follow-up. Two of the six studies (33.3%) demonstrated prior VCF as a significant variable. Age, lumbar bone mineral density, segmental Cobb angle, and vertebral height loss were each described as a significant factor in one of the six studies (16.7%). Identifying patients who are at risk for treatment failure may help select individuals that would benefit from close clinical follow-up or early surgical/procedural intervention.