Low-energy vertebral fractures requiring a fusion in the elderly associate higher mortality than high-energy injuries.

Introduction: Osteoporotic vertebral fractures are associated with excess mortality in the first years after diagnosis. Vertebral augmentation appears to reduce this excess. However, there is no evidence on survival in elderly patients who suffer high-energy impacts and those who require vertebral fusion for treatment. Research question: is mortality in elderly patients with thoracolumbar fractures requiring spinal fusion different according to the mechanism (high vs. low energy trauma)? Which factors predict survival in this group of patients? Material and methods: Patients aged ≥50 years with thoracolumbar fractures who required vertebral fusion for this reason between 2008 and 2021 were retrospectively selected. Survival was determined with the Kaplan-Meier method, and Cox regression analyses were used to determine mortality predictors. Results: The analysis encompassed a total of 141 patients, with a mean age of 66.3 years (SD 10,23) and predominance of female subjects (56 %). The survival probability was found to be significantly higher in patients with high-energy trauma, both in the short and long term, according to the injury mechanism (HR 0.18 [95 % CI 0.08-0.38]; p < 0.001). Multivariable analysis identified low-energy mechanism, Charlson comorbidity index score, and emergent procedures as independent risk factors for mortality. Discussion and conclusion: The findings of this study demonstrate an elevated risk of mortality in elderly patients when the fracture treated with fusion is produced by a low-energy mechanism. This observation may be attributable to the increased fragility of these patients. Individualized patient evaluation is necessary, with a focus on preoperative optimization, particularly in those with higher-risk profiles.