Background: Vertebral compression fractures (VCFs) are the most common fragility fractures associated with low-energy injury mechanisms in postmenopausal women with osteoporosis. No clear consensus is currently available on the optimal timing for surgical intervention in specific cases. Methods: This study examined the correlations between sagittal parameters, functional scores, and the appropriate timing for surgical intervention during the recovery stage in patients with osteoporosis with thoracolumbar (TL) vertebral body fractures. A total of 161 women aged ≥ 65 years with osteoporosis were included in the study. Spinal sagittal parameters from standing plain films and functional outcomes as the Oswestry disability index (ODI) and the visual analogue scale (VAS) were collected. Results: We found that TL junction Cobb angle was significantly correlated with ODI > 30 (p < 0.001) and VAS > 6 (p < 0.001) and the discriminative values for predicting ODI > 30 and VAS > 6 were a TL kyphotic angle of 14.5° and 13.5°, respectively. Among women aged ≥ 65 years with osteoporosis, the back pain and functional impairment observed within 6 months following a compression fracture are associated with a greater TL kyphosis angle. Conclusions: This suggests that a more proactive approach may be necessary when addressing the conditions of these patients.

Background and Objectives: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. Materials and Methods: A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2–C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. Results: At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2–C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. Conclusions: MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient.

This 24-month retrospective, exploratory observational study evaluated longitudinal spinal morphometric changes in 128 postmenopausal women with osteoporosis receiving anabolic therapy (n = 30) or non-anabolic anti-osteoporotic therapy (n = 98). Lumbar BMD, lower lumbar vertebral heights, disc height indices, and sagittal spinopelvic parameters were assessed at baseline and 24 months. Unweighted and baseline-severity adjusted linear regression models were used; IPTW and overlap-weighted analyses were performed as sensitivity analyses. Both groups showed significant lumbar BMD improvement. Patients receiving anabolic therapy were older and had lower baseline lumbar BMD and greater thoracolumbar kyphosis, indicating confounding by indication. In unweighted models, anabolic therapy was associated with greater L5 anterior height loss and L5/S1 disc height index preservation; however, these associations were attenuated after adjustment for baseline lumbar BMD and thoracolumbar kyphosis and were not consistently supported by propensity-score-weighted sensitivity analyses. Pelvic incidence showed more consistent level-specific associations, being negatively associated with L5 anterior height change and positively associated with L5/S1 disc height index preservation. Given substantial confounding by indication and limited treatment-group overlap, treatment-related associations should not be interpreted causally. These findings suggest that spinopelvic morphology may influence lower lumbar structural adaptation, whereas treatment-related morphometric findings remain exploratory and require confirmation.