Radiological Outcomes of Percutaneous Vertebroplasty with Minimal Invasive Stabilization for Patients with Osteoporotic Vertebral Fractures with Neurological Deficits or Significant Instability

Study design: A retrospective study. Objectives: This study assessed the radiologic outcomes of percutaneous cement vertebroplasty with minimally invasive stabilization using percutaneous pedicle screws (PCV-MISt) in osteoporotic vertebral fractures (OVF) with neurological deficits or unstable fractures. Summary of background data: Acute OVF are typically managed conservatively or with PCV. In patients with neurological deficits or unstable fractures caused by ankylosed spine or large intravertebral clefts, fixation with spinal instrumentation may be necessary. Method: This retrospective study evaluated OVF patients treated with PCV-MISt from 2015 to 2022. Demographic and preoperative, immediate postoperative, and latest follow-up radiologic data, including anterior vertebral height (AVH), posterior vertebral height (PVH), wedge endplate angle (WEPA), and regional kyphotic angle (RKA) were measured. Parameters such as correction rate, follow-up correction rate, and loss of correction rate were calculated. Results: This study included 26 OVF patients with a mean age of 75.7±7.8 years. Radiologic parameters, AVH, PVH, WEPA, and RKA, showed significant improvement postoperatively. AVH increased from 15.4±9.0 mm to 22.9±5.5 mm postoperatively, then decreased to 20.8±6.0 mm at follow-up. PVH increased from 25.2±4.2 mm to 27.4±3.3 mm postoperatively, then decreased to 26.4±3.3 mm at follow-up. WEPA improved from 11.4±9.4° to 5.3±5.7° postoperatively, then worsened to 7.1±6.4° at follow-up. RKA improved from 18.0±14.2° to 8.9±12.5° postoperatively, then worsened to 14.0 ±12.2° at follow-up. RKA exhibited the greatest loss of correction rate at 30.7%, followed by AVH at 29.3%, WEPA at 11.1%, and PVH at 3.5%. The complication rate was 11.5%, involving proximal and distal junctional fractures. Conclusion: PCV-MISt is a viable treatment option for OVF patients with neurological deficits or unstable fractures, offering a less invasive alternative in elderly patients.