Surgical Outcomes After Minimally Invasive Direct Lateral Corpectomy with Percutaneous Pedicle Screws for Osteoporotic Thoracolumbar Vertebral Collapse with Neurologic Deficits in the Thoracolumbar Spine Compared with Those After Posterior Spinal Fusion with Vertebroplasty.

Abstract

Retrospective observational study of a cohort of consecutive patients. The aim of this study was to compare surgical invasion, mechanical complications, and clinical and radiological outcomes 2 years after surgery between minimally invasive corpectomy following percutaneous pedicle screw placements (X-core/PPS) and posterior fixation with vertebroplasty (VP) for treating osteoporotic vertebral fractures (OVFs), which failed conservative treatment due to neurological deficits. Numerous studies have proposed surgical procedures to treat OVFs that fail conservative treatment. However, an optimal approach remains controversial because patients often have numerous comorbid medical complications, frequent instrumentation failure, and/or adjacent vertebral fracture (AVF). Recently, a minimally invasive lateral approach has attracted attention as an alternative procedure to the thoracolumbar junction for corpectomy and expandable cage replacement (X-Core Adjustable VBR System). However, its usefulness and validity is largely unknown. A cohort of 102 consecutive patients with OVF at T11-L1 who underwent surgery were followed up for >2 years after surgery. Ultimately 50 patients were included in the VP group and 45 in the X-core/PPS group. Surgical invasion, radiological examinations, and clinical outcomes between two procedures were compared. Both X-core/PPS and VP procedures were safe and acceptable for neurological improvement and surgical invasion. The correction loss of local kyphotic angle (LKA) and occurrence of AVF were significantly less in the X-core/PPS group. Oswestry Disability Index in the X-core/PPS group at 2 years after surgery showed better recovery than that in the VP group, and no revision surgery was needed in the X-core/PPS group. Postoperative correction loss of LKA increased significantly when intraoperative endplate injury developed. This next-generation minimally invasive anterior and posterior combined surgery was found to be a safe and useful procedure for OVF treatment to reduce correction loss, mechanical complication, and AVF, resulting in less postoperative low back pain.Level of Evidence: 3.