title: Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results.
  
  
  BACKGROUND
  Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures.
  
  
  METHODS
  The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison.
  
  
  RESULTS
  The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction.
  
  
  CONCLUSIONS
  The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.
authors: Department of Orthopaedic Surgery, Japan Community Health care Organization Osaka Hospital, Osaka, Japan.
authors: Shota
authors: S
authors: Takenaka
authors: Department of Orthopaedic Surgery, Japan Community Health care Organization Osaka Hospital, Osaka, Japan.
authors: Yoshihiro
authors: Y
authors: Mukai
authors: Department of Orthopaedic Surgery, Japan Community Health care Organization Osaka Hospital, Osaka, Japan.
authors: Noboru
authors: N
authors: Hosono
authors: Department of Orthopaedic Surgery, Japan Community Health care Organization Osaka Hospital, Osaka, Japan.
authors: Takeshi
authors: T
authors: Fuji
keywords: Anterior spinal fusion; Osteoporosis; Posterior closing wedge osteotomy; Single-stage combined anterior-posterior procedure; Vertebral body fracture