INTRODUCTION: Insufficient bone union or nonunion following osteoporotic vertebral fracture (OVF) can cause intractable back pain and neurological deficit in elderly patients. Surgical treatment is usually required for patients with neurological deficit. However, invasive surgery is not a preferable option considering the age and comorbidities of elderly patients. We developed a vertebroplasty method that creates a sufficient cavity by carrying out curettage of fibrous and necrotic tissue in the vertebral body under endoscopic observation, followed by injection of calcium phosphate cement (CPC). This facilitates safe treatment, even for insufficient bone union following OVF with posterior wall injury. We report the outcome of endoscopic vertebroplasty for insufficient bone union following OVF with neurological deficit.
METHODS: Fifteen vertebras of 13 patients with severe back pain and neurological deficit from OVF underwent endoscopic vertebroplasty using CPC in our institution from 2003 to 2008. Visual analogue scale of back pain, ambulatory function and neurological function were evaluated at pre‐ and postoperative selected time points. Sagittal wedging angle (SWA) and percentage vertebral body height (VBH) of the affected vertebra were also evaluated on plain X‐rays. The percentage of canal occlusion was evaluated on sagittal CT images.
RESULTS: The mean VAS of back pain significantly improved from 76.5 preoperatively to 18.7 postoperatively, and was 27.3 at latest follow‐up. Six patients were bedridden before surgery, but all became ambulatory after surgery. The mean percentage of VBH significantly increased and the mean SWA decreased after operation. Although the percentage of canal occlusion was almost unchanged after surgery, neurological improvements were observed in all patients.
DISCUSSION: The present study demonstrated that endoscopic vertebroplasty without instrumentation is a treatment option even for patients with neurological deficits resulting from insufficient bone union following OVF. Correction of intravertebral instability, rather than decompression, facilitated neurological improvement.