Combination of retrospective and prospective study.

We aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.

The clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.

We analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.

In the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05).

For patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.