ORIGINAL ARTICLE Posterior vertebral column resection with 360-degree osteosynthesis in osteoporotic kyphotic deformity and spinal cord compression Marc Dreimann 1 & Axel Hempfing 2 & Martin Stangenberg 1 & Lennart Viezens 1 & Lukas Weiser 3 & Patrick Czorlich 4 & Sven Oliver Eicker 4 Received: 24 October 2016 /Revised: 24 January 2017 /Accepted: 27 February 2017 # Springer-Verlag Berlin Heidelberg 2017 Abstract Osteoporotic fractures with severe kyphosis and neurologic deficits often require decompression and stabilisation. To reduce the risk of procedure-related compli- cations, single-stage posterolateral vertebrectomy and a 360- degree fusion can be performed. An adequate reduction of kyphotic deformity through this approach has not been report- ed. The aim of this study is to investigate the efficacy of kyphotic deformity reduction by this approach in osteoporotic situation. A retrospective analysis and chart review was per- formed for 10 consecutive patients who underwent posterolat- eral decompression and posterior vertebrectomy with dorsal mesh stabilisation and reduction of kyphotic deformity. Preoperative back pain was 8.6 on a visual analogue scale; it was reduced to 5.5 at discharge and 3.7 at the latest follow-up (18 months). The Frankel score improved from D to E (three patients) or was equal (E). Radiological segmental kyphosis was corrected from a mean of 25° to 5° (p < 0.008) postoper- atively with a loss of 3° at follow-up (p < 0.005). Single-stage posterolateral vertebrectomy allow for a fast and safe reconstitution/preservation of neurological function in patients with osteoporotic fracture and kyphotic deformity. A significant correction of often-accompanied hyperkyphosis is possible without neurological deterioration and with an im- proved sagittal profile and good pain reduction. Keywords Osteoporotic vertebral fracture . Kyphosis . Spinal cord compression . Vertebral column recection Abbreviations ODI Oswestry disability index OVC Osteoporotic vertebral collapse VAS Visual analogue scale (p)VCR (posterior) vertebral column resection Introduction The lower thoracic spine and thoracolumbar junction are high- ly susceptible to vertebral fractures. Sixty percent of such lesions are located between T11 and L2 [3, 17]. Given that almost 54 million Americans older than 50 years of age have osteoporosis [30], with an estimated frequency of up to 2 million fractures annually [6], the rate of vertebral fractures is likely to increase due to the ageing population. Beside treatment of the underlying cause of the fracture, simple compression fractures (A1 or A3 according to the AO classification [28]) without neurological symptoms can be treated conservatively, with a brace and pain medication, or surgically, by using the minimally invasive vertebroplasty or balloon kyphoplasty approaches [13, 20, 22]. However, when a neurological deficit is present, these techniques do not pro- vide the opportunity to address the spinal cord compression. Decompression and spinal column stabilisation can be chal- lenging due to the fact that osteoporosis is a systemic disease M. Dreimann and Axel Hempfing contributed equally to this study and therefore share first authorship. * Marc Dreimann m.dreimann@uke.de 1 Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany 2 German Scoliosis Center, Bad Wildungen, Germany 3 Department of Trauma, Orthopedic and Reconstructive Surgery, University Hospital Göttingen, Göttingen, Germany 4 Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany Neurosurg Rev DOI 10.1007/s10143-017-0840-1