title: Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures--anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty.
abstract: OBJECTIVE
  In general, osteoporotic vertebral collapse (OVC) with neurological deficits requires sufficient decompression of neural tissues to restore function level in activities of daily living (ADL). However, it remains unclear as to which procedure provides better neurological recovery. The primary purpose of this study was to compare neurological recovery among three typical procedures for OVC with neurological deficits. Secondary purpose was to compare postoperative ADL function.
  
  
  METHODS
  We retrospectively reviewed data for 88 patients (29 men and 59 women) with OVC and neurological deficits who underwent surgery. Three typical kinds of surgical procedures with different decompression methods were used: (1) anterior direct neural decompression and reconstruction (AR group: 27 patients), (2) posterior spinal shorting osteotomy with direct neural decompression (PS group: 36 patients), and (3) posterior indirect neural decompression and short-segment spinal fusion combined with vertebroplasty (VP group: 25 patients). We examined clinical results regarding neurological deficits and function level in ADL and radiological results.
  
  
  RESULTS
  The mean improvement rates for neurological deficits and ADL function level were 60.1 and 55.0%, respectively. There were no significant differences among three groups in improvement rates for neurological deficits or ADL function level. The VP group had a significantly lower estimated mean blood loss (338 mL) and mean duration of surgery (229 min) than both the AR and PS groups (p < 0.001).
  
  
  CONCLUSIONS
  Direct neural decompression is not always necessary, and the majority of patients can be treated with a less-invasive procedure such as short-segment posterior spinal fusion with indirect decompression combined with vertebroplasty. The high-priority issue is careful evaluation of patients' general health and osteoporosis severity, so that the surgeon can choose the procedure best suited for each patient.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. mkashii-osk@umin.ac.jp
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kashii
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamazaki
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.forename: Takahito
authors.initials: T
authors.lastname: Fujimori
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Nagamoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tamura
authors.forename: Takenori
authors.initials: T
authors.lastname: Oda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohwada
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000150:complications / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D054854:Vertebroplasty / Q000379:methods
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