Abstract
BackgroundLower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR.MethodsThis retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores.ResultsMost of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required.ConclusionsBELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.
Highlights
Osteoporotic vertebral compression fractures (OVCFs), the most common fractures occurring in elderly people, can be managed conservatively and are known to have a benign natural course
Incidental durotomy was reported in two patients and epidural hematomas in another two patients; all patients improved with conservative treatment, and no reoperation was required
BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVCrelated lumbosacral radiculopathy (LSR)
Summary
Osteoporotic vertebral compression fractures (OVCFs), the most common fractures occurring in elderly people, can be managed conservatively and are known to have a benign natural course. Studies have shown that approximately 30% of all OVCFs presents with progressive collapse, 13% accompanied with nonunion, and 3% develops delayed vertebral collapse (DVC) with neurologic deficits [1, 2]. In patients at an advanced age, lower lumbar DVC affecting at or below L3 causes lumbosacral radiculopathy (LSR) [2]. DVC affecting the thoracolumbar junction is accompanied by compressive myelopathy and paralysis, and neurological symptoms may be improved by short-segment posterior lumbar arthrodesis surgery. The problem arises when fragile bone quality, sarcopenia, global spinal imbalance, and medical frailty together pose a challenge and an ethical dilemma toward the treatment of lower lumbar DVC-related LSR in extremely elderly patients [2, 6]. Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR
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