Background Old L5 traumatic fractures with kyphotic deformity are quite rare and surgical management constitutes a significant challenge. Anterior vertebrectomy and reconstruction with O-arm navigation for old L5 traumatic fractures with kyphotic deformity aim to restore spinal stability, correct deformity, and improve functionality. This study evaluates the efficacy and safety of this approach. Methods A retrospective case series was conducted on 43 patients with old L5 traumatic fractures and kyphotic deformity who underwent anterior vertebrectomy and reconstruction using O-arm navigation. Data were collected on operation duration, blood loss, radiological and clinical outcomes (VAS, ODI, ASIA, local Cobb angle, and vertebral anterior margin height ratio), Bridwell classification, and complications. Results The mean operation duration was 182.5 ± 32.8 min, with an average blood loss of 570.5 ± 71.4 mL. All patients had regular follow up with an average duration of 27.1 ± 6.8 months. The VAS scores and ODI at 3 months postoperatively and at the final follow-up showed significant improvement compared to preoperative scores ( P 0.05). VAMHR improved significantly from 35.9 ± 5.6% preoperatively to 92.1 ± 2.1% at the final follow-up ( P 0.001). The LCA at the final follow-up 14.4 ± 3.7° showed statistically significant difference compared to preoperative measurements 37.8 ± 2.4°. Preoperative ASIA grades were C in 1 patient, D in 18 patients, and E in 24 patients. And ASIA grades were D in 9 patients and E in 34 patients at the final follow-up. Wilcoxon signed-rank test showed a significant improvement in ASIA grade at the final follow-up compared with preoperative status ( P 0.001). 11 of 43 patients (25.6%) improved by one grade, 32 of 43 patients (74.4%) remained unchanged. 34 patients achieving Bridwell grade I bone fusion. Complications were minimal, with 1 case of intraoperative venous bleeding successfully managed. Conclusion Anterior vertebrectomy and reconstruction using O-arm navigation is an effective and safe approach for treating old L5 traumatic fractures with kyphotic deformity in the medium term follow-up. It offers significant pain relief, functional recovery, and sustained correction of spinal alignment, with low complication rates and high fusion success.
Chen et al. (Wed,) studied this question.