Reconstruction Procedures for Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficits: A...

Introduction Surgical strategies for osteoporotic vertebral fractures (OVFs) with neurological symptoms remain controversial. Although anterior column reconstruction is recommended for severe vertebral collapse, few comparative studies have evaluated the lateral-posterior combined approach (LP approach) versus the posterior-only approach (P approach) that incorporates three-column osteotomy and cage reconstruction. This retrospective study compared perioperative, radiographic, and functional outcomes between these two approaches in patients with OVFs and neurological deficits. Materials and methods Thirty-eight patients (median age: 75 years; 6 men and 32 women) with thoracolumbar OVFs and neurological deficits were retrospectively analyzed. Twenty-two patients underwent the LP approach (LP group), and 16 underwent the P approach (P group), which involved vertebral column resection and cage insertion. Outcomes evaluated over a two-year follow-up included reoperation rates, neurological status, activities of daily living (ADL), intraoperative blood loss, kyphotic angle correction, and mechanical complications. Results There were no significant differences between the two groups in reoperation rates, neurological recovery, or ADL improvement. Intraoperative blood loss was significantly lower in the LP group (p < 0.05). Both groups achieved satisfactory correction of kyphotic deformities, although correction loss at two years was slightly greater in the LP group. Rates of perioperative and postoperative events, including implant-related complications, did not show clear between-group differences. Conclusions In this multicenter retrospective cohort, both the LP approach and P approach were associated with postoperative neurological and functional improvement at two years. The LP approach was associated with lower blood loss, whereas correction loss at two years was smaller in the P group.