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Table 1 The grading criteria of osteoporotic vertebral compression fractures patients and the corresponding surgical procedures

From: Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases

Grade Grading criterias Surgical methods
Grade I
(N = 86)
1. Recalcitrant back pain, increased pain after activity
2. X-ray showed wedge-shaped changes in the vertebral body, and some patients could see the injured vertebral cavity; CT showed a wedge-shaped change with an internal cavity; MRI showed that the height of the injured vertebra was lost and the internal signal of the cavity was abnormal
Vertebral augmentation
Grade II
(N = 60)
1. Recalcitrant back pain, increased pain after activity
2. X-ray showed wedge-shaped changes in the injured vertebra, while dynamical X-ray film showed obvious changes in the angle of upper and lower endplates and local instability; CT showed a wedge-shaped changes with an internal cavity; MRI showed that the height of the injured vertebra was lost and the internal signal of the cavity was abnormal
Posterior reduction fusion internal fixation or combined vertebral augmentation
Grade III
(N = 44)
1. Recalcitrant back pain, increased pain after activity with radiating pain in the lower extremities or intermittent claudication
2. X-ray showed loss of height of injured vertebra; CT showed wedge-shaped lesions with internal cavities, lumbar spinal stenosis, and compression of the dural sac; MRI showed that the height of the injured vertebra was lost, the signal was abnormal, the dural sac was compressed, and the same level of spinal canal stenosis
Posterior decompression and reduction fusion and internal fixation
Grade IV
(N = 30)
1. Recalcitrant back pain, increased pain after standing for a long time
2. X-ray showed a wedge-shaped change with severe height loss and kyphosis of the spine; CT showed wedge-shaped changes of injured vertebra, internal cavity and kyphosis deformity of spine; MRI showed loss of injured vertebral height, kyphosis of the spine, abnormal signals inside the injured vertebra
Posterior osteotomy with internal fixation and fusion
Grade V
(N = 18)
1. Recalcitrant back pain, aggravated after activity; Or accompanied by radiating pain in lower limbs, intermittent claudication; 2. X-ray showed a wedge-shaped change and kyphosis of the spine; CT showed wedge-shaped change of injured vertebra, kyphosis deformity of spine, lumbar spinal canal stenosis and dural sac compression; MRI showed that the height of the injured vertebra was lost, the signal was abnormal, the dural sac was compressed, and the same level of spinal canal stenosis Posterior osteotomy (decompression) with internal fixation and fusion
  1. The grading is independently assessed by two experienced doctors. If the results are consistent, they will be adopted. If the results are inconsistent, the third doctor will be invited to participate in the assessment, and the evaluation results will be decided by majority opinion