Degenerative lumbar spinal stenosis with osteoporotic vertebral fracture involving endplate: a retrospective study.

Objective: Degenerative lumbar spinal stenosis (LSS) accompanied by osteoporotic vertebral fractures (OVFs) involving the endplate is relatively uncommon and presents therapeutic challenges. This study aims to evaluate the clinical outcomes of surgical treatment in such cases.

Methods: A retrospective analysis was conducted on nine patients diagnosed with LSS and endplate-involved OVFs who underwent surgery at Ruijin Hospital between July 2015 and December 2022. Patients received either decompression with kyphoplasty or fusion with kyphoplasty. All patients were followed for a minimum of 12 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores. Radiographic evaluations, including X-rays and CT scans, were used to assess implant stability, cage subsidence, and fusion status.

Results: The study included 1 male and 8 female patients, aged 72 to 81 years (mean: 76.3 ± 5.2 years). Two patients underwent decompression and kyphoplasty, six underwent fusion and kyphoplasty, and one patient received posterolateral fusion and kyphoplasty due to an enlarged disc space and cage instability. Significant postoperative improvements in VAS and JOA scores were observed and maintained throughout the follow-up period. Radiological follow-up exceeding 12 months revealed no intervertebral height loss or segmental instability in patients who underwent decompression and kyphoplasty. All patients in the fusion group achieved successful fusion without notable complications such as implant loosening or cage subsidence. The patient who underwent posterolateral fusion also experienced no complications, including screw loosening, vertebral height loss, or hardware failure.

Conclusion: Degenerative LSS combined with OVF involving the endplate is a complex clinical condition. Both decompression with kyphoplasty and fusion with kyphoplasty are effective surgical strategies, providing significant and sustained clinical improvement.