Modified Posterior Osteotomy for Osteoporotic Vertebral Collapse with Neurological Dysfunction in Thoracolumbar Spine：a Preliminary Study

Abstract

AbstractObjective:The risk of Osteoporotic Vertebral Collapse(OVC) associated with delayed neurological dysfunction(DND) is high, and surgery for it in the elderly is challenging. How to simplify surgical procedures while preserving surgical efficacy has become a hot topic in treatment. This study aims to provide clinical data to support the advancement of modified posterior osteotomy for the treatment of thoracolumbar OVC with DND by comparing perioperative clinical parameters, imaging data characteristics and changes in efficacy outcome indicators.Methods:12 patients were diagnosed for Osteoporotic Vertebral Collapse in combination with neurological dysfunction. Modified Posterior osteotomy in all patients were designed. The perioperative, and radiological parameters and complications, including surgery duration, blood loss, ASIA grade,VAS, ODI, Regional Kyphosis Angle(RKA), Anterior Vertebral Height ratio(AVHr), Spinal Canal Invasion ratio(SCIr) , were collected retrospectively and analyzed to evaluate the clinical efficacy and safety of this technique.Results:Of the12 patients, Mean age: 65.50 ± 9.70 years, mean follow-up: 29.42 ± 4.98 months, mean operative blood loss: 483.33 ± 141.96 ml, mean operative time: 3.71 ± 0.66 hours, VAS score decreased from preoperative 5.83 ± 0.72 to final follow-up 1.25 ± 0.75 (P<0.05). Post-operative ODI reduced to 31.46%, and postoperative neurological function was significantly improved. The RKA was corrected from 35.8±10.83° to 20.03±3.54° after surgery and to 22.47±3.08° at final follow-up; AVHr% was corrected from 39.32±18.02 to 63.03±14.29 after surgery and to 53.89±8.94 at final follow-up; SCIr% was corrected from 54.88±5.41 to 68.13±5.30 after surgery and to 68.68±6.76 at final follow-up; Spinal canal volume immediately following surgery was increased by 24.14%.Conclusions:Posterior modified osteotomy is an effective treatment for thoracolumbar osteoporotic fractures with OVC combined with DND. It can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function. The simplified osteotomy also has certain advantages in terms of operating time, blood loss, postoperative VAS score and improvement in lumbar function.