Short Versus Long Segment Cement-Augmented MIS Fixation and Indirect Decompression in Osteoporotic Burst Fractures with Incomplete Neurology: Do the Clinical and Radiological Outcomes Differ? A Retrospective Multicentric Study

Abstract Background: Various options exist for the treatment of osteoporotic burst fractures; however, extensive procedures in the elderly can increase morbidity and mortality. Hence, there is a need for minimally invasive approaches addressing both anterior reconstruction and posterior stabilization. We compared the clinical and radiological outcomes of two types of posterior surgery. Materials and Methods: A retrospective multi-center study involving 55 patients with a mean follow-up of 19.48 months was undertaken. Group A ( n = 23): vertebroplasty at index level with percutaneous fixation two levels above and below. Group B: Short segment cement-augmented instrumentation, subdivided into: B1 ( n = 16): vertebroplasty and screws at index level and B2 ( n = 16): index level cement-augmented fenestrated screws. Results: All groups showed significant improvements in visual analog scale (VAS) ( P < 0.001) and Oswestry disability index (ODI) ( P < 0.001) scores at follow-up. Thirty-seven patients (67.27%; 17 from Group A and 20 from Group B) showed complete neurological recovery (to Frankel E). Thirty-six patients (65.45%; 14-A, 22-B) and 15 (27.27%; 9-A, 6-B) patients showed an improvement of one and two grades, respectively. Patients with moderate or good anterior bridging bone formation had lower VAS and ODI scores at follow-up. Mean blood loss in Group B (68.44 ± 11.39 mL) was significantly lower ( P < 0.001) compared to Group A (110.87 ± 24.85 mL). Mean operative time was significantly higher ( P < 0.001) in Group A (136.30 ± 16.53 min) as compared to Group B (100.78 ± 13.16). Common complications in the whole cohort were cement extravasation 4 (12.5% – all in B) and distal screw pull-out (3-A, 1-B2). Conclusions: Cement-augmented index level screws combined with short segment fixation have several benefits, including reduced blood loss and shorter operative times, while delivering similar benefits of long segment fixation.