Minimal-access surgery in managing osteoporotic vertebral fractures with neurological deficits: a preliminary report.

BACKGROUND: Spinal cord compression as a result of osteoporotic vertebral fracture is very rare. Surgical decompression of this recognized complication is indicated when the patient has persistent neurological deficits. Clinically, these patients are usually elderly and in a generally debilitated state. Using formal anterior spinal surgery might significantly violate the patient's respiratory mechanism and increase operative mobidity or mortality. METHODS: From January 1996 to June 1998, the authors used a minimal-access spinal approach to perform 1-stage decompressive corpectomy, interbody fusion, and internal fixation with a Reduction-Fixation titanium spinal plate (Trifix, San Leandro, CA, USA) by thoracoscopic assistance in 8 patients with osteoporotic vertebral fractures from T11 to L1, and neurological deficits. This involved a modified 2-portal technique that required a 2-cm wound in order to initially introduce the thoracoscope, and a minithoracotomy wound (usually 5-6 cm) for surgical manipulation. RESULTS: None of the operations resulted in injury to the great vessels, internal organs, or spinal cord. The average followup period was 30 months (range, 22-50 months). Complications included 1 radiolucent line around a vertebral screw, 1 lateral migration of a vertebral screw with bone graft displacement, 1 transient incisional wound hypesthesia, and 1 iliac donor site pain. In the current patients, the average neurological recovery was 1.1 grades on the Frankel scale. CONCLUSION: The authors advocate that such a minimal-access technique with thoracoscopic assistance presented in the current study is an ideal alternative in treating patients with osteoporotic vertebral fractures and neurological deficits. It can obviate the necessity of dividing the diaphragm in order to facilitate exposure; no patient in the current series required intensive care postoperatively. However, the stability of the vertebral screw purchase in the osteoporotic spine is a matter of concern.