Twenty-two patients with neurologic deficit due to delayed posttraumatic vertebral collapse after osteoporotic compression fractures of the thoracolumbar spine underwent anterior decompression and reconstruction with bioactive Apatite-Wollastonite containing glass ceramic vertebral prosthesis and Kaneda instrumentation. Eighteen patients previously had minor trauma that resulted in a mild vertebral compression fracture without any neurologic involvement and were either conservatively treated or not treated at all. Four had no history of back injury. The preoperative neurologic status was incomplete paralysis in all patients. The average age at surgery was 66(53–79) years. The average follow-up was 34 (20–58) months after surgery. All patients had returned to their daily living with neurologic recovery and stable spine. This type of anterior procedure is effective in the osteoporotic patients and there was a very low incidence of instrumentation failure and very low morbidity.