Although all 18 patients initially received conservative treatment, neurologic symptoms subsequently developed, and vertebral collapse progressed gradually. In 14 patients, BEPLD was performed simultaneously with VP under epidural anesthesia. In the remaining 4, BEPLD was performed when the neurologic symptoms persisted even after a percutaneous VP was performed. In both cases, BEPLD was performed in the manner described by Kim et al. [911]. There are two surgical methods of BEPLD, namely, biportal endoscopic unilateral laminectomy bilateral decompression (BE-ULBD) and biportal endoscopic unilateral foraminal decompression (BE-UFD). The surgical method used was determined on the basis of the patient’s symptoms and lesions observed on an MRI scan. Also, VP was performed with a polymethyl methacrylate (PMMA) cement filling through the pedicle of the fractured vertebra. All procedures were performed using a uniform technique (Fig. (Fig.1).1). To avoid bias, two independent assessors, not involved in the surgery, evaluated the postoperative outcomes.

Representative clinical example where surgeries were performed using a uniform technique. A 90-year-old female patient was diagnosed with L4 osteoporotic vertebral collapse (concave-type), severe central canal and right foraminal stenosis at L3-L4, and L3 spondylolisthesis with instability. (A) Plain lateral radiographic image. (B) Dynamic flexion radiographic image. (C) Magnetic resonance T2-weighted sagittal image. (D) Magnetic resonance T1-weighted fat-suppression sagittal image. (E, F) The patient underwent percutaneous balloon kyphoplasty for L4 osteoporotic vertebral collapse but continued to experience severe radicular pain and its related gait disturbance. (G) Finally, she underwent unilateral biportal endoscopic decompressive laminectomy. Sufficient neural decompression of the right L3 exiting nerve root (black star), right L4 traversing nerve root (white star), and left L4 traversing nerve root (black cross) are shown by endoscopic visualization. The same can be seen on the preoperative (H) and postoperative (I) magnetic resonance T2-weighted axial images

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