Development and internal validation of a clinical prediction model for acute adjacent vertebral fracture after vertebral augmentation

Aims To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score. Methods In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism. Results Of the 377 patients used for model derivation, 58 (15%) had an acute AVF postoperatively. The following preoperative measures on multivariable analysis were summarized in the five-point AVA score: intravertebral instability (≥ 5 mm), focal kyphosis (≥ 10°), duration of symptoms (≥ 30 days), intravertebral cleft, and previous history of vertebral fracture. Internal validation showed a mean optimism of 0.019 with a corrected AUC of 0.77. A cut-off of ≤ one point was chosen to classify a low risk of AVF, for which only four of 137 patients (3%) had AVF with 92.5% sensitivity and 45.6% specificity. A cut-off of ≥ four points was chosen to classify a high risk of AVF, for which 22 of 38 (58%) had AVF with 41.5% sensitivity and 94.5% specificity. Conclusion In this study, the AVA score was found to be a simple preoperative method for the identification of patients at low and high risk of postoperative acute AVF. This model could be applied to individual patients and could aid in the decision-making before vertebral augmentation. Cite this article: Bone Joint J 2022;104-B(1):97–102.

Impact of the COVID-19 pandemic on osteoporotic vertebral fracture incidence and follow-up at the emergency department. A retrospective study of a tertiary hospital in southern Spain

The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.