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

Introduction: The purpose of this retrospective study was to evaluate the results of spinal canal decompression and anterior column support via posterior vertebral column resection (PVCR), performed for eliminating the disadvantages of the anterior approach, in the management of osteoporotic vertebral fractures with neurological deficits in elderly patients. Materials and Methods: Twenty-six patients (20 females and 6 males) with more than 2 years of follow-up were included. The fractures were in the thoracic spine in 14 patients, and thoracolumbar spine in 12. Five patients had ASIA C and 21 patients had ASIA D neurologic deficits. Surgical technique included placement of cement augmented pedicle screws, followed by laminectomy or hemilaminectomy, unilateral or bilateral pediculectomy, sacrifice of nerve roots between Th2 and Th11, decompression of the spinal canal by subtotal or total vertebrectomy, and support of the adjacent discs and anterior column by titanium mesh. In cases where decompression can be achieved with unilateral approach, contralateral posterior elements were preserved for fusion. Prophylactic vertebroplasties were made in one level above and one level below in all patients. Radiographic analysis was made with local kyphosis angle (LKA) measurements. Changes in the neurological conditions, clinical outcomes and complications were also evaluated. Results: Mean age was 70.4 (62-84) years, and mean follow-up was 36.5 months (18-72). Mean level of instrumentation was 5.1 (4-8), operation time was 310 (140-410) minutes, and blood loss was 460 (320-700) ml. Mean preoperative LKA of 21.5 degrees improved to 4.6 degrees after the operation and was 5 degrees at the final follow-up. VAS was 7 before the operation, 4 after, and 2 at final follow-up. Full neurologic recovery was achieved in all patients. There were no pseudoarthroses. The major complication was adjacent segment fracture that required revision was made 2 patients (7.69%). The minor complications were superficial wound infections in 3 patients (11.5%), and dural tear in 3 patients (11.5%). Conclusion: Decompression of the spinal canal and reconstruction of the anterior column via a posterior approach provided satisfactory results in osteoporotic elderly patients. This procedure obviated the need for an anterior approach, which might have caused significant morbidity in these elderly patients. In cases where decompression can be achieved with unilateral approach, preservation of contralateral posterior elements (lamina, pedicle, facet joints) might have helped to obtain higher fusion rates because a 270 degrees fusion is provided.