Assessment of risk factors for the vertebral body kyphotic deformity progression in patients with type A1 injuries of the thoracolumbar junction




thoracolumbar junction, wedge-shaped compression fracture, progressive deformity, risk factors, nomogram


More than 60% of traumatic injuries of the spine occur in the zone of the thoracolumbar junction (TLJ), and 60–75% of these fractures are of a compression nature. Type A1 injuries are characterized by the least osteo-destructive changes compared to other injuries. Traditionally, they are treated conservatively. A number of studies conducted in the last 10 years, shows a high rate of failure of conservative treatment, as evidenced by the progression of kyphotic deformity of the compressed vertebral body. Most of these publications are devoted to osteoporotic lesions in aged patients, while this aspect has been little studied in patients of working age with normal bone density.

Objective: to evaluate the factors influencing the risk of kyphotic deformity progression in patients of working age with type A1 traumatic injuries of the thoracolumbar junction.

Materials and methods. The analysis of clinical cases of patients who visited the outpatient department of Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2019 to 2022 with traumatic damage to the TLJ zone. Forty-seven victims who met the selection criteria were selected. Gender, age, body mass index, level of damage, location of the damaged endplate (caudal or cranial), bone tissue radiodensity, angular kyphotic deformity of the vertebral body, and pain intensity were considered as predictors. Depending on the presence or absence of deformity progression 2 months after the injury, the patients were divided into two clinical groups. The most clinically significant predictors were identified using the LASSO (Least Absolute Shrinkage and Selection Operator) regression method.

Results. LASSO screening identified five potential predictors. The final logistic regression model after regularization demonstrated high predictive performance: the area under the ROC curve (AUC) was 0.907, and the predictive accuracy was 85%. When assessing the risk of kyphotic deformity progression in traumatic injuries of type A1 of the TLJ zone, age, bone density, angular kyphotic deformity of the vertebral body, and pain intensity are of the greatest importance, demonstrating a directly proportional relationship. A compressed caudal endplate is also associated with a higher risk of post-traumatic progression of angular kyphosis. The nomogram developed using the mentioned factors makes it possible to quantify the degree of risk when choosing a therapy strategy.

Conclusions. The performed analysis made it possible to create a nomogram for predicting the increase in kyphotic deformity of the vertebral body in A1 fractures of TLJ region. The proposed model can be used for a rational assessment of the risk degree when choosing the optimal tactics for treating patients.


1. Yuan H, Guo Q, Zhang Z, Ou L, Wang H, Yu H, et al. Sex, age, role and geographic differences in traumatic spinal fractures caused by motor vehicle collisions: a multicentre retrospective study. Sci Rep. 2023;13(1):3712. [CrossRef] [PubMed]

2. Zileli M, Sharif S, Fornari M. Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. 2021;18(4):704-712. [CrossRef] [PubMed]

3. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-2037. [CrossRef] [PubMed]

4. Madassery S. Vertebral Compression Fractures: Evaluation and Management. Seminars in interventional radiology. 2020;37(2):214-219. [CrossRef] [PubMed]

5. Kim GH, Cho TG. A Comparative Study on the Treatment of Osteoporotic Vertebral Compression Fractures With Early Ambulation and at Least 1 Week of Absolute Bed Rest. Korean journal of neurotrauma. 2022;18(1):56-63. [CrossRef] [PubMed]

6. Petitt JC, Desai A, Kashkoush A, Ahorukomeye P, Potter TO, Stout A, et al. Failure of Conservatively Managed Traumatic Vertebral Compression Fractures: A Systematic Review. World Neurosurg. 2022;165:81-88. [CrossRef] [PubMed]

7. Soultanis K, Thano A, Soucacos PN. "Outcome of thoracolumbar compression fractures following non-operative treatment". Injury. 2021;52(12):3685-3690. [CrossRef] [PubMed]

8. Costachescu B, Popescu CE, Iliescu BF. Analysis of the Classification Systems for Thoracolumbar Fractures in Adults and Their Evolution and Impact on Clinical Management. Journal of clinical medicine. 2022;11(9). [CrossRef] [PubMed]

9. Abdalla MA, Rodrigues R, Ulbricht C. Vertebral Augmentation for Painful Type 4 Osteoporotic Compression Fractures: A Comparative Study. Journal of osteoporosis. 2023;2023:1562892. [CrossRef] [PubMed]

10. Duvuru A, Hawkins SP. Percutaneous vertebroplasty: efficacy in the management of pain related to acute vertebral compression fractures. The New Zealand medical journal. 2023;136(1571):65-72. [PubMed]

11. Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057-1063. [CrossRef] [PubMed]

12. Patil S, Nene AM. Predictors of kyphotic deformity in osteoporotic vertebral compression fractures: a radiological study. European Spine Journal. 2014;23(12):2737-2742. [CrossRef]

13. Henry MJ, Pasco JA, Sanders KM, Nicholson GC, Kotowicz MA. Fracture Risk (FRISK) Score: Geelong Osteoporosis Study. Radiology. 2006;241(1):190-196. [CrossRef] [PubMed]

14. Maynard FM, Jr., Bracken MB, Creasey G, Ditunno JF, Jr., Donovan WH, Ducker TB, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266-274. [CrossRef] [PubMed]

15. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):2399-2404. [CrossRef] [PubMed]

16. Zou D, Li W, Deng C, Du G, Xu N. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J. 2019;28(8):1758-1766. [CrossRef] [PubMed]

17. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2006;17(12):1726-1733. [CrossRef] [PubMed]

18. Boskey AL, Imbert L. Bone quality changes associated with aging and disease: a review. Annals of the New York Academy of Sciences. 2017;1410(1):93-106. [CrossRef] [PubMed]

19. Nih Consensus Development Panel on Osteoporosis Prevention D, Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785-795. [CrossRef] [PubMed]

20. Nguyen HS, Soliman HM, Patel M, Li L, Kurpad S, Maiman D. CT Hounsfield Units as a Predictor for the Worsening of Traumatic Vertebral Compression Fractures. World Neurosurg. 2016;93:50-54. [CrossRef] [PubMed]

21. White AA, 3rd, Panjabi MM, Thomas CL. The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res. 1977(128):8-17. [PubMed]

22. Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. J Orthop Trauma. 2009;23(8):588-594. [CrossRef] [PubMed]

23. Beall DP, Phillips TR. Vertebral augmentation: an overview. Skeletal Radiol. 2022. [CrossRef] [PubMed]

24. Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins. 2021;13(4). [CrossRef] [PubMed]

25. Almeida M, Laurent MR, Dubois V, Claessens F, O’Brien CA, Bouillon R, et al. Estrogens and Androgens in Skeletal Physiology and Pathophysiology. Physiological reviews. 2017;97(1):135-187. [CrossRef] [PubMed]

26. Compston JE. Sex steroids and bone. Physiological reviews. 2001;81(1):419-447. [CrossRef] [PubMed]

27. King TC. Tissue Homeostasis, Damage, and Repair. In: King TC, editor. Elsevier’s Integrated Pathology. Philadelphia: Mosby; 2007. p. 59-88.

28. Hsu Y, Hsieh TJ, Ho CH, Lin CH, Chen CK. Effect of compression fracture on trabecular bone score at lumbar spine. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2021;32(5):961-970. [CrossRef] [PubMed]

29. Männistö S, Harald K, Kontto J, Lahti-Koski M, Kaartinen NE, Saarni SE, et al. Dietary and lifestyle characteristics associated with normal-weight obesity: the National FINRISK 2007 Study. The British journal of nutrition. 2014;111(5):887-894. [CrossRef] [PubMed]

30. Zhao P, Xu A, Leung WK. Obesity, Bone Loss, and Periodontitis: The Interlink. Biomolecules. 2022;12(7). [CrossRef] [PubMed]



How to Cite

Nekhlopochyn, O. S., Verbov, V. V., Cheshuk, I. V., & Vorodi, M. V. (2023). Assessment of risk factors for the vertebral body kyphotic deformity progression in patients with type A1 injuries of the thoracolumbar junction. Ukrainian Neurosurgical Journal, 29(3), 26–33.



Original articles