The challenge of OF5 vertebral fractures treatment: a modified muscle-preserving surgical technique and case-series presentation with a minimum 2-Year follow-up

PURPOSE: The surgical management of severe osteoporotic vertebral fractures (OF5 type) is complex and lacks a standardized approach. This study aimed: (1) to describe a modified surgical technique designed to offer broad exposure of the spine while preserving the paraspinal musculature; and (2) to present a case series of 15 OF5 patients with a 2-year follow-up. METHODS: system vertebroplasty and navigated posterior fixation performed through a modified perfascial approach, which preserved muscular integrity and minimal fascial dissection. The demographic characteristics of the included cases were reported at baseline. The intraoperative outcomes were duration of surgery, number of instrumented vertebrae, and blood loss. The preoperative and postoperative outcomes were vertebral kyphotic angle (VKA), and the vertebral height (VH) measured on radiography. Statistical analysis was performed with R Software. RESULTS: In the 15 patients, a mean of 4.1 vertebrae (min. 2 - max. 6) were instrumented, with a mean operative time of 200.7 ± 80.4 min (min. 101 - max. 373 min). Mean blood loss was 246.9 ± 234.1 mL (min. 0 - max. 700 mL). Two postoperative complications occurred. All the radiographic parameters (VKA and VH) improved postoperatively: mean VKA improved from 17.8 ± 6.4° preoperatively to 6.0 ± 4.7° at 12 months and 6.9 ± 4.9° at final follow-up (p < 0.001); mean medial/posterior vertebral height ratio improved from 55.2 ± 16.9% to 87.1 ± 11.9% at 12 months and 74.6 ± 11.8% at final follow-up (p < 0.001). The improvement was stable at the latest long-term follow-up. CONCLUSIONS: In this technical note and consecutive case series, the described technique was associated with favorable radiographic outcomes, low complication rates and acceptable blood loss. These preliminary findings suggest potential benefit, but prospective comparative studies are needed to confirm efficacy and safety.