title: Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits.
abstract: BACKGROUND
  With the increase of the elderly population, osteoporotic vertebral fractures have been frequently reported. Surgical intervention is usually recommended in osteoporotic vertebral collapse with neurologic deficits. However, very few reports on surgical interventions exist.
  
  
  OBJECTIVE
  To compare surgical results of anterior and posterior procedures for treating osteoporotic thoracolumbar vertebral collapse with sustained neurologic deficits.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Fifty patients who sustained osteoporotic thoracolumbar vertebral collapse with neurologic deficits were treated either by anterior decompression and strut graft (n=32) or by posterior decompression and pedicle screw fixation with vertebroplasty (n=18).
  
  
  METHODS
  Incidence of complications, sagittal Cobb angle, spinal canal encroachment, and Japanese Orthopedic Association score.
  
  
  METHODS
  The authors retrospectively reviewed the results of a consecutive series of patients undergoing anterior decompression and strut graft or posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Operative notes, clinical charts, and radiographs were analyzed.
  
  
  RESULTS
  Operative time was similar between the groups, but intraoperative blood loss was significantly lower in the posterior group. All patients showed neurologic recovery. No significant difference was observed in the neurologic improvement, kyphosis correction angle, and loss of correction. Perioperative respiratory complications were found in 11 patients (34%) in the anterior group. In the anterior group, early posterior reinforcement was required in patients with very low bone density below 0.60 g/cm(2) and/or in those with three segments of instrumentation for two vertebral collapses. Posterior group patients did not undergo additional surgery.
  
  
  CONCLUSIONS
  Anterior reconstruction for osteoporotic vertebral collapse is significant because anterior elements, particularly those at the thoracolumbar junction, play a major role in load bearing. However, difficulties arise when anterior reconstruction is performed in cases with very low bone density and in those with multiple vertebral collapse.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: hidekisudo@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sudo
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kaneda
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.forename: Ken
authors.initials: K
authors.lastname: Nagahama
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001863:Bone Screws; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae; D054854:Vertebroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
keywords: Anterior surgery; Osteoporotic vertebral collapse; Posterior surgery