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Introduction: This study aimed to investigate the clinical and radiological outcome of "indirect decompression" using lateral-posterior combined surgery for osteoporotic vertebral fracture (OVF) with neurological symptoms., Methods: A total of 17 patients who underwent lateral and posterior combined indirect decompressive spinal reconstruction (LP-IDR) for single-level OVF with neurological symptoms were included in this study. The neurological symptoms (sensory disturbance and muscle weakness) and imaging findings (local angle and height of the fracture segment and bone fragment occupancy in the spinal canal) were investigated preoperatively, postoperatively, and at the 1-year follow-up., Results: Muscle weakness was observed preoperatively in ten patients. Nine patients had complete recovery of muscle weakness ( p <0.001), whereas one had residual muscle weakness at the 1-year follow-up. The presence of sensory disturbance was observed in 16 patients preoperatively, and it was significantly reduced to 8 patients at the 1-year follow-up ( p =0.003). The bony fragment occupancy rate in the spinal canal was decreased from 44.0% to 40.2% postoperatively ( p =0.04) and to 33.1% at 1 year ( p =0.002). The local angle was corrected from 8.3° to -2.6° postoperatively ( p =0.003) and to 1.2° at 1 year. The local height was corrected from 26.7 to 32.0 mm postoperatively ( p <0.001) and to 29.8 mm at 1 year., Conclusions: LP-IDR for OVF with neurological symptoms provided sufficient neurological improvement with expansion of the spinal canal over time., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2024 The Japanese Society for Spine Surgery and Related Research.)