Surgical techniques for osteoporotic vertebral collapse with delayed neurological deficits: A systematic review

Osteoporotic vertebral collapse (OVC) with delayed neurological deficits (DND) is one severe subtype of OVC, for which surgical intervention is more complicated and difficult. Although many individual case reports and series have described the surgery for stabilization and neurological decompression of OVC with DND, no systematic review has been published.

We searched eligible studies in PubMed, SCOPUS, EMBASE and ISIWeb of Knowledge for eligible studies and conducted comprehensive analysis.

A total of 29 publications involving 596 patients of OVC with DND were included in this review. There are 36.6%, 60.6% and 2.8% of patients receiving anterior neural decompression and reconstruction, posterior surgery which can be further divided into 6 distinct groups, and posteroanterior surgery, respectively. Among them, patients in the posteroanterior surgery had the longest time (351.0 min) for operation and the largest volume of mean blood loss (2892.0 ml). For clinical outcomes, patients in the posterior spinal shortening osteotomy with direct neural decompression group had the most significantly LKA correction effect, with mean LKA correction 21.3°, while the posterior decompression and posterior column reconstruction group exhibited the lowest LKA correction loss rate (14.7%).

Although the optimal treatment has not been determined for patients of OVC with DND in this study, our analysis could provide guidance for choosing an appropriate approach. Besides, effective treatment for OVC with DND requires multidisciplinary collaboration, such as geriatricians, interventional radiologists, respiratory disease experts, and spine surgeons. On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.