BACKGROUND AND IMPORTANCE: Osteoporotic vertebral burst fractures are an increasingly common cause of pain and severe functional disability in the elderly. Although anterior-posterior surgical stabilization offers an efficacious and durable treatment, the associated high blood loss, long durations of surgery, and prolonged hospitalization are often not tolerable for elderly patients, who are most often medically frail with multiple comorbidities. CLINICAL PRESENTATION: We report a case of an L2 osteoporotic burst fracture in an elderly patient with significant comorbidities treated with a minimally invasive tubular direct lateral transpsoas approach for L2 vertebrectomy and anterior cage placement. The construct was supplemented by a percutaneous pedicle screw construct and adjacent level vertebroplasty. Duration of surgery was 3.5 hours with a total of 35 mL blood loss. The patient was discharged ambulating 36 hours after surgery and reported marked improvement in pain, disability, and quality of life measures at 6 weeks postoperatively. CONCLUSIONS: L2 vertebrectomy by direct lateral transpsoas tube systems supplemented by percutaneous pedicle screws can be performed safely and may allow for anterior column decompression and reconstruction in elderly or comorbid patients not otherwise able to tolerate traditional stabilization procedures.
BACKGROUND AND IMPORTANCE: Osteoporotic vertebral burst fractures are an increasingly common cause of pain and severe functional disability in the elderly. Although anterior-posterior surgical stabilization offers an efficacious and durable treatment, the associated high blood loss, long durations of surgery, and prolonged hospitalization are often not tolerable for elderly patients, who are most often medically frail with multiple comorbidities. CLINICAL PRESENTATION: We report a case of an L2 osteoporotic burst fracture in an elderly patient with significant comorbidities treated with a minimally invasive tubular direct lateral transpsoas approach for L2 vertebrectomy and anterior cage placement. The construct was supplemented by a percutaneous pedicle screw construct and adjacent level vertebroplasty. Duration of surgery was 3.5 hours with a total of 35 mL blood loss. The patient was discharged ambulating 36 hours after surgery and reported marked improvement in pain, disability, and quality of life measures at 6 weeks postoperatively. CONCLUSIONS: L2 vertebrectomy by direct lateral transpsoas tube systems supplemented by percutaneous pedicle screws can be performed safely and may allow for anterior column decompression and reconstruction in elderly or comorbid patients not otherwise able to tolerate traditional stabilization procedures.