Asian Spine J.  2014 Jun;8(3):322-330. 10.4184/asj.2014.8.3.322.

Major Surgical Treatment of Osteoporotic Vertebral Fractures in the Elderly: A Comparison of Anterior Spinal Fusion, Anterior-Posterior Combined Surgery and Posterior Closing Wedge Osteotomy

• Takenaka S
• Mukai Y
• Hosono N
• Fuji T

• KMID: 2270351
• DOI: http://doi.org/10.4184/asj.2014.8.3.322

Abstract

STUDY DESIGN: A retrospective study. PURPOSE: To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results. OVERVIEW OF LITERATURE: Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures.
METHODS
The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison.
RESULTS
The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction.
CONCLUSIONS
The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.

Keyword

Osteoporosis; Vertebral body fracture; Posterior closing wedge osteotomy; Single-stage combined anterior-posterior procedure; Anterior spinal fusion

MeSH Terms

Aged*
Back Pain
Follow-Up Studies
Humans
Kyphoplasty
Kyphosis
Osteoporosis
Osteotomy*
Retrospective Studies
Spinal Fusion*
Surgical Procedures, Minimally Invasive