Minimally Invasive Treatment Using Biportal Endoscopic Decompression with Vertebroplasty for Osteoporotic Vertebral Compression Fractures in Older Adult Patients.

BACKGROUD: Osteoporotic vertebral compression fractures (OVCFs) with neurological symptoms often require extensive fusion surgery, which carries significant risks for older adults. This study evaluated the clinical outcomes of biportal endoscopic lumbar decompression (BELD) combined with percutaneous vertebroplasty (PVP) as a minimally invasive alternative.

METHODS

We retrospectively analyzed 21 older adults (mean age, 80.24 years) who underwent BELD with PVP for OVCFs between July 2017 and June 2022. Indications included neurological deficits or severe, intractable pain refractory to conservative treatment. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions (EQ-5D), and modified MacNab criteria. Radiographic parameters included vertebral compression rate and wedge angle.

RESULTS

The mean operation time was 86.81 minutes, with an average blood loss of 136.19 mL. According to modified MacNab criteria, 76.2% of patients achieved excellent or good outcomes. Clinical parameters, including VAS, ODI, and EQ-5D, showed significant improvement over 24 months (p < 0.001). Neurological function improved in most patients, with the number of Frankel grade 5 cases increasing from 14 to 17. Radiographic parameters demonstrated significant initial improvement at 3 months (p < 0.001); however, changes were not statistically significant over time. Complications included cement leakage (4 cases), adjacent fracture (2 cases), and 1 revision surgery; no major perioperative complications or mortality occurred.

CONCLUSIONS

BELD combined with PVP is a safe and effective, minimally invasive option for older adults with OVCFs and neurological symptoms. This technique provides adequate neural decompression and vertebral stabilization while minimizing the risks associated with extensive fusion surgery in this vulnerable population.