Modified posterior closing-wedge osteotomy using a biportal endoscopic approach for osteoporotic vertebral collapse: a retrospective case series

Osteoporotic vertebral compression fractures are typically benign; however, they can progress to osteoporotic vertebral collapse (OVC) or nonunion, often accompanied by kyphotic deformity, severe pain, and neurological deficits, making treatment difficult. Compared to conventional vertebral corpectomy procedures, modified posterior closing wedge osteotomy (mPCWO) offers advantages, such as reduced blood loss and shorter operative time, while achieving effective correction of kyphotic deformities and providing significant pain relief. We hypothesized that mPCWO performed using a biportal endoscopic (BE) approach provides effective correction of kyphotic deformity and favorable clinical outcomes in patients with OVC while reducing surgical morbidity. In this study, we present the surgical technique and preliminary outcomes of BE-mPCWO for the treatment of OVC. Between May 2022 and November 2024, nine patients with OVC underwent BE-mPCWO. Under general anesthesia, the patient was placed in the prone position, and an ipsilateral total facetectomy was performed. After inserting a guidewire for vertebral osteotomy, a partial pediculo-vertebrotomy was performed. Following subtotal discectomy, a lordotic interbody cage was inserted into the intervertebral disc. Posterior instrumentation spanning one to three motion segments was performed with an emphasis on restoring sagittal alignment as much as possible. Perioperative kyphotic angles, sagittal vertical axis, neurological status, and complications were recorded. Additionally, perioperative Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared. The mean age was 74.6 ± 6.5 years, and the mean follow-up was 15.2 ± 2.8 months (median 15, range 12–20). The mean operative time was 203.9 ± 12.2 min, with a mean blood loss of 170.0 ± 32.8 mL. The mean correction of segmental lordosis was + 19.2 ± 11.1°. Sagittal imbalance and pelvic incidence–lumbar lordosis mismatch improved significantly after surgery ( P < 0.05). The mean ODI score improved from 59.4 ± 13.1 preoperatively to 37.4 ± 6.2 at the final follow-up, and the mean VAS score for back pain improved from 7.7 ± 0.7 to 3.7 ± 0.9 (both P < 0.05). Complications occurred in three, none of which required revision surgery. BE-mPCWO may be a technically feasible option for OVC, providing kyphotic correction, pain relief, and functional recovery with limited blood loss. These are preliminary findings from a small uncontrolled series and require confirmation in comparative studies.