Incidence of thoracic vertebral fracture in COVID 19 patients receiving intensive treatment for severe pneumonia.

Abstract

Background and purpose: The COVID-19 pandemic has had a complex impact on the incidence of spinal fractures. In 2020, Luigi di Filippo et al. published a surprising retrospective monocentric (in Milan) clinical study. X-rays of 114 COVID-19 infected pneumonia patients were examined in the first wave of pandemic and thoracic vertebral fractures were confirmed in 36% of the patients. They demonstrated that pneumonia patients with thoracic vertebral fractures required longer hospitalization and were significantly more likely to require mechanical ventilation. The mortality rate of pneumonia patients with thoracic vertebral fractures was 22%, compared to 10% without thoracic vertebral fractures.

Methods: During the second wave of COVID-19, 220 patients were treated in our hospital for COVID pneumonia. We processed the data of these patients and compared them with the Milan results. In addition, we analyzed the entire literature available on this topic. Each patient's pneumonia was confirmed by chest CT. We decided which patients developed a vertebral fracture based also on CT. CT analysis was performed by two independent neuroradiologists. We comprehensively analyzed the clinical, pulmonological and radiological conditions of our patients.

Results: The mean age of our 220 COVID pneumonia patients was 56.8 years. Pneumonia was GGO dominant in 76.3% of our patients. The mean hospitalization of the patients was 8.3 days. Noninvasive ventilation was required in 7.7% of our patients, and invasive ventilation in 11.4%. We confirmed a thoracic vertebral fracture only in 2 of our 220 patients. There was no significant difference in age, comorbidities, and symptoms between the patients in Milan and our study; however, a significant difference was demonstrated in the incidence of thoracic vertebral fractures.

Conclusion: According to our retrospective study, with vitamin D supplementation, careful patient rotation, and complex intensive care, the rate of thoracic spine fractures in patients with very severe COVID pneumonia can be reduced to below 1%.