Abstract
Objective: How to treat osteoporotic vertebral compression fractures with significant canal stenosis and neurologic compromise remains controversial. In this article, we present a less invasive method to treat such cases by performing vertebroplasty with polymethyl methacrylate (PMMA) and a decompression procedure at the same time without fusion. Clinical Materials and Methods: Seven patients (seven women) with a mean age of 74.0 years (age range, 59 to 85 years) were included in this study. All patients suffered severe back pain, compression-induced radicular deficits and gait disorder. The surgical treatment consisted of percutaneous transpedicular vertebroplasty with PMMA followed by microsurgical fenestration, and decompression of the spine. We evaluated back pain, JOA score, gait function and vertebral body height before and shortly after surgery. Results: The mean duration from the onset of symptoms to surgery was 5.3 months (range, 2-10 months). All patients showed pain relief. Mean JOA score significantly improved from 10.6 on admission to 20.3 at discharge. The average increase in vertebral body height 1 week after surgery was 4.5mm anteriorly, 4.6mm centrally, and 1.1mm posteriorly. Three nonambulatory patients became ambulatory following surgery, and three of four patients with neurogenic claudication had no postoperative limitations. Conclusion: This less invasive method could reduce back pain, increase vertebral body height and improve gait function at least in the short duration followed after surgery. This study is too small and the follow-up period is too short to substantiate this method. Although a larger series should be evaluated in the future, this approach may be possibly useful for vertebral compression fractures in elderly patients particularly those with high risk of instrument failure because of severe osteoporosis.
