Indirect Decompression of Osteoporotic Vertebral Compression Fracture Using Intraoperative Motor Evoked Potential Monitoring-Guided Ligamentotaxis

Abstract

Osteoporotic vertebral compression fractures have become common in aging societies and can lead to a decreased quality of life with severe back pain and neurological deficits. Traditional direct decompression and stabilization surgeries can produce sufficient decompression and provide good results. However, after surgical treatment, some elderly patients with numerous chronic diseases often experience severe postoperative complications owing to the long surgery duration and massive bleeding. Therefore, to prevent perioperative morbidity, other surgical methods that simplify the surgical process and reduce the operation time are required. Herein, we describe a case of indirect decompression using ligamentotaxis and sequential anabolic agents. To examine their effectiveness during surgery, we monitored intraoperative motor-evoked potentials. The patient's neurological symptoms improved postoperatively. After the operation, the anabolic agent "romosozumab" was injected monthly to treat osteoporosis, prevent additional fractures, and accelerate posterolateral fusion. On serial follow-up, the anterior body height of the fractured vertebra improved significantly, demonstrating the importance of osteoporosis treatment using anabolic agents. Indirect decompression surgery may have early effects, whereas sequential anabolic agent use may consolidate the long-term effects of surgical treatment.