Study Design. A prospective cohort study (Level 3). Objective. To develop and validate a clinical scoring system (Osteoporotic Vertebral Fracture Conservative Treatment Prognosis Score, OVF-CTPS) for predicting the prognosis of conservative treatment in patients with osteoporotic vertebral fractures (OVFs), addressing clinical uncertainty in treatment selection. Summary of Background Data. OVFs face uncertainty in choosing conservative vs. surgical management. 10–40% of patients have conservative treatment failure (e.g., non-union, collapse). Existing classification systems lack prognostic value, highlighting the need for a practical predictive tool. Methods. 201 patients with acute OVFs undergoing conservative treatment were prospectively followed for 6 months. Baseline assessments included demographics, pain, quality of life measures, and multimodal imaging (X-ray, CT, MRI). The primary outcome was conservative treatment failure. Independent predictors were identified using multivariate logistic regression and weighted to create the OVF-CTPS, which was validated using receiver operating characteristic (ROC) analysis Results. The conservative treatment failure rate was 29.9%. Six independent predictors were identified: Sugita “bow-shaped” or “concave” type, standing vertebral collapse degree <80%, middle column/posterior wall injury, T2WI “diffuse low” signal, STIR linear black signal, and basivertebral foramen involvement. The OVF-CTPS (range 0–13) demonstrated excellent predictive performance (AUC=0.918). At an optimal cutoff score of 6, the sensitivity was 91.3% and specificity was 84.0%. The low-risk group (score <6) had a 96.3% treatment success rate, while the high-risk group (score ≥6) had a success rate of 32.3% Conclusion. The OVF-CTPS is a validated prognostic tool that integrates fracture morphology, injury severity, and MRI-based perfusion markers. It accurately stratifies patients based on their risk of conservative treatment failure, enabling clinicians to identify low-risk patients suitable for conservative care and high-risk patients who may benefit from early surgical evaluation
Ao et al. (Thu,) studied this question.