Surgical management of radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study

Background Radiculopathy of lower limb after acute osteoporotic vertebral fracture (OVF) in lower lumbar spine (LLS) is uncommon in geriatric patient. Surgical intervention is indicated in patient who is irresponsive to conservative treatment. The optimum operative strategy is controversial considering the poor general condition of this population. Herein we provided an algorithm for surgically managing this clinical scenario, hoping to provide reference for surgical decision. Methods We retrospectively studied the patients who suffered new-onset radiculopathy of lower limb after acute single-level OVF in LLS underwent surgical intervention in our department. The demographics, bone mineral density (BMD), AO classification of vertebral fracture, the preexisting degenerative changing (foraminal stenosis, lumbar disc herniation, etc.), and the fashion of surgical intervention were collected. The clinical outcomes, including pre- and postoperative Visual Analog Scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria of response to surgery, were evaluated. Result From Sep 2019 to Dec 2021, twenty two patients with mean age and T-score of 68.59 ± 9.74 years and 2.86 ± 1.03, respectively, were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Fifteen patients (45.4)% were diagnosed with A1 type of AO classification, in which 11 patients (80.0%) were characterized by collapse of inferior end-plate. Three patients (13.6%) suffered A2 type fracture, while four patients (18.2%) suffered A3 type fracture. Preexisting degenerative changing was observed in 54.5% of all patients. Sixteen patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Three patients underwent posterior instrumentation and fusion, two patients underwent secondary endoscopic foraminoplasty, one patient underwent secondary radiofrenquency ablation. The mean follow-up period was 17.42 ± 9.62 months. Mean VAS for leg/back pain and ODI were significantly decreased after surgery ( P < 0.05). Based on the Macnab criteria, the total satisfaction rate was 90.9% at the last follow-up. Conclusion Patient with OVF which involved inferior end-plate is predisposed to suffer lower-limb radiculopathy. PKP alone or with other minimally-invasive surgery is safe and effective for treating stable fracture. Aggressive surgical intervention should be considered in patient with unstable fracture or severe foraminal encroachment.