ArticleBrain & spine2026
The bisegmental Cobb angle in osteoporotic spine fractures: Does it influence treatment decision or functional outcome?
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Osteoporotic vertebral compression fractures (OVCF) represent a growing clinical challenge and the effect of bisegmental Cobb angles in treatment decision and outcome prediction for remains unclear. Material and methods: This prospective multicenter study analyzed 350 patients with thoracolumbar OVCF (OF2-OF4). Bisegmental Cobb angles (CA) were measured at the day of treatment decision, discharge, and follow-up. Associations with treatment, OF classification, pain, and functional outcomes were analyzed. Results: Patients treated with instrumentation showed more pronounced kyphotic alignment than conservatively treated patients at baseline (-11 ± 12° vs. -7 ± 14°, p = 0.042). CA correlated weakly with OF-Score (r = -0.167, p = 0.002) and OF classification (r = -0.195, p < 0.001), but not with pain (p = 0.789). ROC analyses demonstrated poor discriminatory power of CA for treatment (AUC = 0.557, p = 0.078); the predefined kyphosis threshold of -15° was not predictive. Multinomial logistic regression confirmed that OF classification (p < 0.001) and pain intensity (p < 0.001), but not CA (p = 0.310), independently predicted the performed treatment. Over time, surgically treated patients achieved significant fracture reduction (-6 ± 7° during hospitalization, p < 0.001) with partial loss at follow-up, whereas conservatively treated patients showed progressive increased kyphosis. CA were not consistently associated with functional outcomes. Discussion and conclusion: The CA alone has limited value for guiding treatment decisions in thoracolumbar OVCF, and fixed angular thresholds are not clinically useful. However, restoration of
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