Abstract
The objective of this study was to introduce and validate a novel developed scoring system tailored specifically for osteoporotic vertebral compression fractures (OVCFs), aiming to provide guidance for treatment selection. A retrospective analysis spanning from March 2016 to March 2021 was conducted on 208 patients diagnosed with osteoporotic vertebral compression fractures (OVCFs) who received conservative treatment. Patients were categorized into low-score (47 cases), medium-score (98 cases), and high-score (63 cases) groups based on the Novel Assessment System for OVCFs (NASOVCF) scores. Comparative analyses of radiographic and clinical data were performed, and logistic regression analysis was used to determine the risk factors for bone non-union and progressive kyphosis. The high-score group exhibited significantly inferior outcomes, characterized by higher Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores (P < 0.05), increased vertebral height loss, and kyphosis angle differences compared to the low and medium-score groups (P < 0.05). Notably, a bone union rate of 38.1% (24/63) was observed in the high-score group, significantly lower than that of the low-score group (97.9%, 46/47). Furthermore, the progressive kyphosis rate was 47.6% (30/63) in the high-score group, significantly higher than the 17.3% (17/98) observed in the medium-score group and the 2.2% (1/46) observed in the low-score group. In multivariate analysis, higher NASOVCF score emerged as an independent risk factor for bone non-union (OR = 1.713, 95% CI 1.458-2.013, P < 0.001). Similarly, higher NASOVCF score (OR = 1.373, 95% CI 1.203-1.568, P < 0.001), along with female gender and higher pre-treatment ODI score, were identified as independent risk factors for progressive kyphosis. The area under the curve (AUC) for bone non-union and progressive kyphosis were 0.895 and 0.835, respectively, indicating robust discriminative performances. Higher NASOVCF score was identified as a significant risk factor for non-union and progressive kyphosis following conservative treatment in OVCFs. NASOVCF score emerged as a crucial predictor for adverse outcomes in patients at high risk who underwent conservative management. Surgical interventions such as vertebral augmentation may represent a potentially superior option for individuals with high NASOVCF scores.