Dynamic Orthosis versus Threee-point Orthosis in Treating Osteoporosis Fractures in the Elderly: a Perspective Study

Introduction: The incidence of vertebral fractures from osteoporosis (VFO) is rapidly increasing as the population ages. In the U.S., more than 250,000 orthoses were prescribed in 1987 and the three-point orthosis (3P) is the one most commonly used. The Spinomed dynamic orthosis (Medi GmbH & Co. KG), introduced in 1991, represents a valid alternative. We compared the Spinomed orthosis with the 3P orthosis in terms of efficacy and safety in treating VFOs. Materials and methods: 43 patients (18 males and 25 females, ranging from ages 65-93 with an average age of 82.2) with VFO from compression, recruited consecutively between July 2011 and June 2012, were divided into two groups: Group A, treated with the 3P orthosis and Group B, treated with Spinomed. All of the patients had refused a Kyphoplasty operation. The clinical and radiological follow-up with vertebral column X-rays was measured at 1, 3, and 6 month intervals post-trauma. The patients were evaluated, both upon entering the study and during the follow-up, with VAS, Oswestry Low Back Pain Disability Questionnaire (OLBPDQ) and Cobb Angle measurement. We also calculated the Delmas Index to evaluate the degree of resistance of the spine. The height of the vertebral fracture was measured upon entering the study and at 6 months posttrauma. Lastly, we evaluated complications encountered during the 6-month study. Results: There were no statistically significant differences between the two groups in VAS pre-trauma, upon entering the study, and after one month of treatment. After 3 months the average VAS was 5.9 for Group A and 4.9 for Group B with a significant difference (p<0.05). At 6 months, the VAS was significantly lower in Group B (3.9) with respect to Group A (5.0) (p<0.05). The average score of the OLBPDQ pre-trauma was lower in Group A (42.6) with respect to Group B (44.6) (p<0.05), while upon entering the study and after one month the difference was not significant. At 3 months, the OLBPDQ was 63.6 for Group A and 57.3 for Group B with a significant difference (p<0,05), which was verified again after 6 months (Group A 43.6, Group B 37.5; p<0.05). There was no statistically significant difference between the two groups when entering the study or during follow-up with regards to Cobb’s Angle, the Delmas Index, and loss of vertebral body height. Complications related to the orthoses were reported by 14 patients in Group A and only 3 patients in Group B. Discussion and conclusion: The scope of static corrective treatment is to prevent the development of kyphotic deformations and reduce pain. The effects on pain and postural correction are results of a reduction in the thoracic kyphosis or to an increase in the lumbar lordosis. The 3P orthosis has been, up until now, a valid method of restraint and stabilization in cases of VFO. The Spinomed, first made in 1991, can be adjusted according to the shape of the vertebral column of each individual patient. It fulfills the function of cushioning the load forces on the spine with the main support at the level of the thoracolumbar tract which, thanks to conformable support extending from the sacrum to the upper thoracic spine, creates a balanced distribution of the pressure on the back. It has two leverage points on the sternal body and pubic symphysis while the belts traction the trunk in hyperextension. The weak point of the 3P orthosis is the increased intra-abdominal pressure beyond biomechanical limits. The Spinomed also has the advantage of not sliding in the cranial-caudal direction during walking or strain. In our study, with equal effectiveness of stabilizing the VFO, patients treated with the Spinomed, on average, had a major reduction in pain and an improved quality of life with fewer complications.