• Sanganagouda Patil, Saurabh Rawall, Deepak Singh, Kapil Mohan, Premik Nagad, Bhavin Shial, Uday Pawar, and Abhay Nene.
• Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400016 Maharastra, India. sanganpatil9@gmail.com
• Eur Spine J. 2013 Apr 1; 22 (4): 883891883-91.

PurposeTo report morphological patterns of osteoporotic vertebral compression fractures (OVCFs) presenting for surgery. To describe surgical options based on fracture pattern. To evaluate clinical and radiological outcome.MethodsForty consecutively operated OVCFs nonunion patients were retrospectively studied. We define four patterns of OVCFs that needed surgical intervention. Group 1 mini open vertebroplasty (N = 10) no neurologic deficits and kyphotic deformity, but with intravertebral instability and significant radiological spinal canal compromise. Group 2 with neurologic deficits (N = 24) (2A)-transpedicular decompression (TPD) with instrumentation (N = 14). Fracture morphology similar to (1) and localized kyphosis <30° (2B)-pedicle subtraction osteotomy (PSO) with instrumentation (N = 10). Fracture morphology similar to (1) and local kyphosis >30°. Group 3 posterolateral decompression with interbody reconstruction (N = 06) endplate(s) destroyed, with instability at discovertebral junction, with neurologic deficit. Average follow-up was 34 months. VAS, ODI and Cobb angle were recorded at 3, 6, 12 months and yearly.ResultsThere was significant improvement in the clinical (VAS and ODI) scores and radiologic outcome in each group at last follow-up. 30 patients out of 40, had neurologic deficits (Frankel's grade C = 16, Frankel's grade D = 14). The motor power gradually improved to Frankel's grade E. Average duration of surgery was 97 min. Average blood loss was 610 ml.ConclusionDifferent surgical techniques were used to suit different fracture patterns, with good clinical and radiological results. This could be a step forward in devising an algorithm to surgical treatment of OVCF nonunions.

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