Neurospine.  2021 Jun;18(2):319-327. 10.14245/ns.2040812.406.

Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients

• Pehlivanoglu T
• Erdag Y
• Oltulu I
• Akturk UD
• Korkmaz E
• Yildirim K
• Sarioglu E
• Gun K
• Ofluoglu E
• Aydogan M

• KMID: 2517180
• DOI: http://doi.org/10.14245/ns.2040812.406

Abstract

Objective
This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain.
Methods
One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically.
Results
Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p = 0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p < 0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately.
Conclusion
Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures’ sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.

Keyword

Osteoporotic thoracolumbar vertebrae fractures; Geriatric population; Modified posterior vertebral column resection; Anterior column restoration; Local kyphosis angle; Quality of life