STUDY DESIGN: Retrospective cohort. PURPOSE: To review the clinical presentation of operated patients with delayed neurological deficits after osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE: Delayed neurological deficits can occur from 1 week to 5.7 months after OVFs. Baba has reported 78% good-to-excellent improvement (i.e., ≥50%) after 20 posterior (Cotrel-Dubousset) and 7 anterior (Kaneda in 4, Zielke ventral derotational spondylodesis in 2, and un-instrumented anterior fusion in 1) fusions. Predictive factors for neurological deficits include burst type, vacuum sign, kyphosis, angular instability, and retropulsion. METHODS: Patients with neurological deficits after OVF who received spinal operations between 2000 and 2016 were included. RESULTS: Totally, 28 patients with a mean age of 77 years underwent surgery. Neurological deficits occurred at an average of 5.4 weeks after the onset of back pain. The most common site was L1. Burst fracture was present in 14 patients and vacuum sign in seven. Surgery was performed within an average of 3.9 days of the onset of neurological deficit. Baba's score improved significantly from 5.96 to 9.81, with good-to-excellent improvement in 18 (64%) patients. Better outcomes based on Baba's scores (improvement>60% [median]) were associated with compression fractures, preoperative retropulsion of < 41%, and correction of >16%. Poor improvement in Baba's scores ( < 25%) was associated with surgical complications and burst fracture type. Twenty-two patients (79%) regained walking ability, and seven of 15 (47%) patients demonstrated improved sphincter control at the latest follow-up. Six Frankel grade B patients did not achieve neurological recovery, four of whom exhibited postoperative surgical complications and died at 2 years because of medical problems. Implant migration occurred in six patients, albeit this was of no clinical significance. CONCLUSIONS: Although OVFs are commonly considered benign, delayed neurological deficits can occur. The significant improvement in clinical function after surgery for neurological deficits is associated with compression (and not burst) fractures, lack of surgical complications, and optimal restoration of retropulsion.
Back Pain ; Cohort Studies ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Neurologic Manifestations ; Osteoporosis ; Retrospective Studies ; Spinal Fractures ; Spinal Fusion ; Vacuum ; Walking

Methods: In this retrospective study, we reviewed 37 IL and 34 CL approaches. Postoperative magnetic resonance imaging of the segment involved was carried out on the same day as the operation for comparison with preoperative imaging. Radiological assessments of recess angle, recess height, facet length, and recess dural sac diameters were compared. In addition, pre- and postoperative Visual Analog Scale (VAS) pain scores for the lower limb were analyzed. Results: For IL versus CL approaches, we observed statistical differences in the postoperative recess angle (36.0° vs. 43.7°), recess height (4.27 vs. 5.06 mm), and the dural sac expansion ratio for recess diameter (1.54 vs. 2.17). There was better preservation of facet length in the CL approach than in the IL approach (91.9% vs. 83.7%). There was no difference in VAS improvement between the groups (69.3% vs. 63.6%). Conclusions Unilateral biportal decompression via the CL interlaminar approach may offer better lateral recess clearance and facet preservation than can be achieved via the IL approach. Larger-scale studies are needed for better delineation and for correlation of radiological features with clinical manifestations.

We discuss the technical details and operative advantages of approaching pathologies from the contralateral side in cases of asymmetric spinal stenosis. The contralateral approach offers better manipulative freedom and a more accessible target approach along the plane of the pathology, allowing safer decompression and facet preservation; further, this approach is ergonomic for surgeons. We recommend the adoption of this approach in decompressing asymmetric spinal stenosis.