Outcomes of Perioperative Complications and Mortality in Octogenarians with Traumatic Osteoporotic Thoracolumbar Fractures

Overview

This retrospective study analyzed perioperative complications and mortality in patients aged 80 years and older with traumatic osteoporotic type 4 and 5 thoracolumbar and lumbar fractures. It identified key risk factors influencing outcomes and provided data on surgical management and follow-up over three years.

Background

The geriatric population is rapidly increasing worldwide, with individuals aged 80 and older expected to triple by 2050. Osteoporotic thoracolumbar fractures are common in this age group and pose significant challenges due to decreased bone density, neurological reserve, and comorbidities. Surgical management with posterior instrumentation and cement-augmented screws is recommended for unstable fractures, but advanced age and comorbidities increase the risk of perioperative complications and mortality. There is a lack of focused studies on morbidity and mortality in octogenarians with these fractures, motivating this retrospective analysis.

Data Highlights

Patients aged ≥80 years with traumatic osteoporotic type 4 and 5 fractures were included. Data collected included demographics, comorbidities (Charlson comorbidity index), neurological status (motor score), surgical details, perioperative complications, ICU stay, readmissions, reoperations, and mortality. Follow-up was conducted up to 72 months post-surgery. Surgical treatment involved 4 to 6 cement-augmented pedicle screws depending on fracture type and patient status. Preoperative imaging included CT and MRI to assess fracture morphology and ligament integrity.

Key Findings

• Increasing age and poor premorbid neurological status were associated with higher perioperative and postoperative complication rates.
• Comorbidities assessed by the Charlson comorbidity index significantly influenced mortality risk in octogenarians undergoing surgery for osteoporotic thoracolumbar fractures.
• Type 4 fractures were generally treated with four cement-augmented pedicle screws, while type 5 fractures required six due to greater instability.
• Interdisciplinary evaluation and individualized surgical planning helped balance surgical duration and risk, aiming to preserve spinal stability while minimizing complications.
• Postoperative care included transfer to ICU or normal ward based on intraoperative events and patient condition, with pain management following WHO guidelines.

Clinical Implications

Clinicians should carefully evaluate comorbidities and neurological status when planning surgical intervention for octogenarians with osteoporotic thoracolumbar fractures. Individualized surgical strategies that consider fracture type and patient frailty can optimize outcomes. Close perioperative monitoring and appropriate postoperative care are essential to reduce complications and mortality in this vulnerable population.

Conclusion

This study highlights the importance of comprehensive assessment and tailored surgical management in octogenarians with traumatic osteoporotic thoracolumbar fractures to improve morbidity and mortality outcomes. Further prospective studies are needed to refine treatment protocols in this growing patient demographic.

References

1. German Society for Orthopaedics and Trauma (DGOU) -- Recommendations for Osteoporotic Fracture Classification
2. World Health Organization -- WHO Analgesic Ladder
3. Charlson ME et al. -- Charlson Comorbidity Index