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Surgical treatment for osteoporotic vertebral collapse with neurological deficits: Retrospective comparative study of three procedures—anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty

Abstract

Purpose

In general, osteoporotic vertebral collapse (OVC) with neurological deficits requires sufficient decompression of neural tissues to restore function level in activities of daily living (ADL). However, it remains unclear as to which procedure provides better neurological recovery. The primary purpose of this study was to compare neurological recovery among three typical procedures for OVC with neurological deficits. Secondary purpose was to compare postoperative ADL function.

Methods

We retrospectively reviewed data for 88 patients (29 men and 59 women) with OVC and neurological deficits who underwent surgery. Three typical kinds of surgical procedures with different decompression methods were used: (1) anterior direct neural decompression and reconstruction (AR group: 27 patients), (2) posterior spinal shorting osteotomy with direct neural decompression (PS group: 36 patients), and (3) posterior indirect neural decompression and short-segment spinal fusion combined with vertebroplasty (VP group: 25 patients). We examined clinical results regarding neurological deficits and function level in ADL and radiological results.

Results

The mean improvement rates for neurological deficits and ADL function level were 60.1 and 55.0 %, respectively. There were no significant differences among three groups in improvement rates for neurological deficits or ADL function level. The VP group had a significantly lower estimated mean blood loss (338 mL) and mean duration of surgery (229 min) than both the AR and PS groups (p < 0.001).

Conclusion

Direct neural decompression is not always necessary, and the majority of patients can be treated with a less-invasive procedure such as short-segment posterior spinal fusion with indirect decompression combined with vertebroplasty. The high-priority issue is careful evaluation of patients’ general health and osteoporosis severity, so that the surgeon can choose the procedure best suited for each patient.

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Acknowledgments

Medical editor Katharine O’Moore-Klopf, ELS (East Setauket, NY) provided professional English-language editing of this article before its final acceptance for publication. This work was supported by Health and Labor Sciences Research Grants for Comprehensive Research on Aging and Health from the Ministry of Health, Welfare, and Labor of Japan. None of the authors has any financial interest with any of the commercial entities mentioned in this article.

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Correspondence to Masafumi Kashii.

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Kashii, M., Yamazaki, R., Yamashita, T. et al. Surgical treatment for osteoporotic vertebral collapse with neurological deficits: Retrospective comparative study of three procedures—anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J 22, 1633–1642 (2013). https://doi.org/10.1007/s00586-013-2759-8

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  • DOI: https://doi.org/10.1007/s00586-013-2759-8

Keywords

  • Osteoporotic vertebral collapse
  • Delayed paralysis
  • Anterior surgery
  • Posterior spinal shorting osteotomy
  • Vertebroplasty