Introduction: The International Osteoporosis Foundation has estimated that worldwide, approximately 30–50% of people aged over 50 years are at risk for the development of fragility fractures secondary to osteoporosis. Vertebral compression fractures occur in 20% of people older than 70 years and in 16% of postmenopausal women. The majority of fractures heal with conservative treatment after 8–10 weeks. Surgery is indicated for patients who present with neurological deficits, deformities, and incapacitating pain with conservative treatment failure. Two percent of patients with osteoporotic vertebral fractures (OVFs) develop cord compression. This study aimed to identify the clinical presentation and predictors of clinical outcomes among patients operated for delayed neurological deficits after OVFs.
Materials and methods: eight cases—five women, three men, dorsolumbar junction—seven cases, dorsal spine one case. Neurological status – ASIA B – 1 – ASIA C – 5 – ASIA D – 2. All cases underwent posterior short segment fixation (pedicle screws one level above and below the fracture vertebra) and percutaneous vertebroplasty and indirect decompression.
Results and analysis: Postoperatively neurology improved up to ASIA grade E – 7, grade D – 1. All patients were followed up with neurological assessment every 2 weeks up to 3 months and every month up to 6 months. One patient could not walk, and seven patients walked with assistance. Two patients had sphincter disturbance. The mean preoperative Baba's score was 6 and postoperative score was 11 after follow-up. The mean values of lateral anterior vertebral body height (LAH) were 41.0% preoperatively and 60.7% postoperatively, and lateral posterior vertebral body height (LPH) were 37.4% preoperatively and 58.8% after 6 months postoperatively. The average retropulsion was 36.5%.
Conclusion: Although OVFs are common and generally considered benign, severe and delayed neurological deficits can occur following spinal cord compression. In experienced hands and with appropriate patient selection, posterior short segment fixation (PSF) and vertebroplasty is a safe and efficacious procedure for the treatment of osteoporotic compression fractures with neurological deficit.
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