Modified Posterior Vertebral Column Resection for the Treatment of Osteoporotic Fractures with Neurological Deficits in Elderly Patients

Abstract

Introduction The purpose of this retrospective study was to evaluate the results of spinal canal decompression and anterior column support via modified posterior vertebral column resection (PVCR) (Unilateral hemilaminectomy, pediculectomy, subtotal vertebrectomy) performed for eliminating the disadvantages of the anterior or combined A + P approaches, in the management of osteoporotic vertebral fractures with neurological deficits in elderly patients. Patients and Methods A total of 55 patients (40 females and 15 males) with more than 2 years of follow-up were included in this study. The fractures were in the thoracic spine in 16 patients, and thoracolumbar spine in 39 patients. Overall, 11 patients had ASIA grade C and 41 patients had ASIA grade D neurological deficits. Clinical and radiological outcome and complications were also evaluated. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, and decompression of the spinal canal by subtotal vertebrectomy, and support of anterior column by titanium cage. Contralateral facet joint fusion and grafting was made. Prophylactic vertebroplasties were made in one level above and one level below in all patients. Results Mean age was 74.2 years (range, 66–92), and mean follow-up was 43.5 months (range, 28–102). Mean operation time was 252 minutes (range, 160–340), and blood loss was 580 mL (range, 420–800). Mean preoperative local kyphosis angle was 18.5 degrees and improved to 4.2 degree after the operation and 4.8 degree at the final follow-up. Visual analog scale (VAS) score was eight before the operation and improved to two at final follow-up. Full neurological recovery was achieved in all patients. There were no pseudoarthroses. The major complication was adjacent segment fracture was made three patients (5.4%). The minor complications were superficial wound infections in five patients and dural tear in four patients (16.3%). Conclusion Treatment of osteoporotic vertebral fracture with neurological deficit is a challenging procedure in elderly patients. Modified PVCR provides effective decompression of neural structures. Contralateral intact lamina, pedicle, and cortex of the vertebra increase primary stability and provides more bony surface for fusion.