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Kan D, Wang J, Qiao G, Chen Y, Han D. Efficacy and safety of hollow pedicle screw-anchored bone cement combined with posterior long-segment fixation for Stage III Kümmell's disease. Jt Dis Relat Surg 2025; 36:15-23. [PMID: 39719897 PMCID: PMC11734856 DOI: 10.52312/jdrs.2024.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/20/2024] [Indexed: 12/26/2024] Open
Abstract
OBJECTIVES The study aimed to evaluate the efficacy and safety of hollow pedicle screw-anchored bone cement combined with posterior long-segment fixation (LSF) for the treatment of Stage III Kümmell's disease. PATIENTS AND METHODS The study retrospectively analyzed 23 patients (18 females, 5 males; mean age: 70.1±6.2 years; range, 58 to 80 years) with Stage III Kümmell's disease who underwent hollow pedicle screw-anchored bone cement combined with posterior LSF between March 2017 and April 2020. The clinical efficacy was evaluated using the Visual Analog scale (VAS), the Oswestry Disability Index (ODI), anterior vertebral height, kyphotic Cobb angle, and neurological function by Frankel classification. Complications, operation time, intraoperative blood loss, and complications were obtained from the hospital records. Data recorded at three time intervals (before the surgery, early postoperative period, and the last follow-up) were compared. RESULTS The mean follow-up time was 20.8±6.1 months. The mean operation time was 102±16.5 min, and the mean intraoperative blood loss was 225±41.3 mL. The VAS, ODI, anterior vertebral heights, and local kyphosis angle showed statistically significant differences between preoperative and postoperative values, as well as the preoperative and the final follow-up values (p<0.05). However, the differences between postoperative and final follow-up values were not statistically significant (p>0.05). Six patients (26%) had mild preoperative neurological deficits and normalized neurological function at the final follow-up evaluation. Asymptomatic leakage of cement occurred in five (22%) cases. There was no fixation failure (rod breakage or screw loosening). CONCLUSION Hollow pedicle screw-anchored bone cement combined with posterior LSF is a safe and effective surgical option for the treatment of Stage III Kümmell's disease.
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Affiliation(s)
| | | | | | | | - Dongping Han
- Department of Orthopedic, Affiliated Hospital of Hebei University of Engineering, Handan City, Hebei Province, 056000, China.
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Mao B, Wang W, Wang Q, Li L. A novel treatment option for Kummell's disease using percutaneous kyphoplasty with a mesh-hold bone filling container. Sci Rep 2024; 14:29069. [PMID: 39580562 PMCID: PMC11585556 DOI: 10.1038/s41598-024-80890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 11/22/2024] [Indexed: 11/25/2024] Open
Abstract
Percutaneous kyphoplasty (PKP) is an effective, minimally invasive treatment for Kummell's disease, but challenges like cement leakage, fracture, and displacement remain. This study explores the use of PKP with a mesh-hold bone filling container for this disease.A retrospective analysis was conducted on nine Kummell's disease cases treated with this technique at a spinal surgery department from June 2016 to May 2022. Pre- and postoperative evaluations included X-rays, CT scans, and 3D reconstructions. Parameters like vertebral heights, kyphotic angle, operation time, blood loss, and bone cement issues were measured. Efficacy was assessed using ODI and VAS scores.Statistical analysis showed no significant difference in posterior vertebral height before and after treatment. All other indexes improved significantly postoperatively and at follow-up. No cement leakage or displacement occurred.PKP with a mesh-hold bone filling container is a promising treatment for Kummell's disease. It enhances reduction quality, ensures adequate bone cement filling, and reduces issues related to cement leakage, fracture, and displacement.
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Affiliation(s)
- Bingyan Mao
- Department of Orthopaedic Surgery, The People's Hospital of Shimen County (Shimen Hospital of Changsha Medical University), Changde, Hunan, 415300, China.
| | - Wencong Wang
- Department of Orthopaedic Surgery, The People's Hospital of Shimen County (Shimen Hospital of Changsha Medical University), Changde, Hunan, 415300, China
| | - Qiang Wang
- Department of Orthopaedic Surgery, The People's Hospital of Shimen County (Shimen Hospital of Changsha Medical University), Changde, Hunan, 415300, China
| | - Lei Li
- Department of Orthopaedic Surgery, The People's Hospital of Shimen County (Shimen Hospital of Changsha Medical University), Changde, Hunan, 415300, China
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Wang J, Zhang J, Huang J, Chen J, Dong Q, Zhu H, Huang X, Luo J. Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease. Medicine (Baltimore) 2024; 103:e39960. [PMID: 39465754 PMCID: PMC11460861 DOI: 10.1097/md.0000000000039960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Indexed: 10/29/2024] Open
Abstract
This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.
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Affiliation(s)
- Jian Wang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianxin Zhang
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Jianbiao Huang
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Jie Chen
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Qunwei Dong
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hui Zhu
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xusheng Huang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianxian Luo
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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Chen S, Yang D, Zhuo C, Zhou Z, Aleem HB, Huang L, Chen H. Comparative analysis of percutaneous vertebroplasty and kyphoplasty in the treatment of Stage III Kummell's disease without neurological symptoms: a retrospective study. J Orthop Surg Res 2024; 19:515. [PMID: 39192332 PMCID: PMC11348757 DOI: 10.1186/s13018-024-05019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE This study analyzes the safety and efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) treatments for Stage III Kummell's disease without neurological symptoms, comparing the advantages and disadvantages of these two minimally invasive surgical methods. METHODS A retrospective analysis was conducted on 53 patients with non-neurological Stage III Kummell's disease treated with PVP and PKP at our hospital from December 2018 to January 2023. Patients were divided into PVP (25 cases) and PKP (28 cases) groups based on the surgical method. There were no significant differences in general preoperative data between the two groups (all p > 0.05), ensuring comparability. The study compared surgical duration, volume of bone cement injected, distribution pattern of bone cement, rate of bone cement leakage, and preoperative, postoperative, and final follow-up scores of Visual analogue scale(VAS) and Oswestry disability index(ODI). Additionally, relative anterior height of the injured vertebrae, and Cobb angle of deformity, along with their changes at preoperative, postoperative, and final follow-up stages were calculated and analyzed. RESULTS No significant preoperative differences were observed between the groups (p > 0.05). The PKP group had longer surgeries, higher cement volumes (p < 0.001), and lower leakage rates (p < 0.05), with primarily chunky cement distributions versus mixed distributions in the PVP group. No complications other than cement leakage occurred. VAS and ODI scores showed no significant changes at various time points (p > 0.05) but improved significantly from preoperative (p < 0.001). Both groups saw improved vertebral heights and Cobb angles post-surgery (p < 0.05), with more significant improvements in the PKP group (p < 0.05). Over time, both groups experienced gradual vertebral height loss and increased Cobb angles, more pronounced in the PKP group (p < 0.05). At the final follow-up, there were no statistical differences in vertebral height and Cobb angle between the two groups (p > 0.05). CONCLUSION The study evaluates the safety and efficacy of PVP and PKP for Stage III Kummell's disease without neurological symptoms, comparing the merits of both minimally invasive techniques.
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Affiliation(s)
- Shiwen Chen
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China
| | - Diao Yang
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China
| | - Can Zhuo
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China
| | - Zhenyu Zhou
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China
| | - Hamza Bin Aleem
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China
| | - Ling Huang
- Department of Public Health, College of Medicine and Health Sciences, China Three Gorges University, Yichang, China
| | - Haidan Chen
- Department of Spine Surgery, First Clinical Medical College of Three Gorges University, Yichang, 443003, Hubei, China.
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Guo J, Bai Y, Li L, Wang J, Wang Y, Hao D, Wang B. A Comparative Study of 2 Techniques to Avoid Bone Cement Loosening and Displacement After Percutaneous Vertebroplasty Treating Unstable Kummell Disease. Neurospine 2024; 21:575-587. [PMID: 38763157 PMCID: PMC11224748 DOI: 10.14245/ns.2347274.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/21/2024] Open
Abstract
OBJECTIVE Percutaneous vertebroplasty (PVP) is currently the most common surgical procedure for unstable Kummell disease (KD), but cement loosening or displacement often occurs after PVP. We had been using percutaneous pediculoplasty (PPP) or a self-developed bone cement bridging screw system to avoid this severe complication. This study intends to compare these novel surgical procedures through a 2-year follow-up evaluation. METHODS From May 2017 to May 2021, 77 patients with single-level unstable KD were included in the PPP group, and 42 patients received the PVP-bone cement bridging screw system were included in the screw group. The changes in the vertebral body index (VBI), bisegmental Cobb angle, visual analogue scale (VAS) and Oswestry Disability Index (ODI) and the cement loosening rate and displacement rate at different follow-up time points were used to evaluate the clinical efficacy. RESULTS There was no significant difference in VBI or bisegmental Cobb angle between the 2 groups (p > 0.05) before operation, immediately after operation and at 6-month followup, while at 1-year and 2-year postoperative evaluations, the screw group had higher VBI and bisegmental Cobb angle than the PPP group (p < 0.05). Before operation, immediately after operation, at 6-month and 1-year follow-up, there was no significant difference in VAS or ODI score between the 2 groups (p > 0.05), while at 2-year follow-up, the screw group still had higher VAS and ODI scores than the PPP group (p < 0.05). No bone cement displacement occurred in both groups, but the rate of bone cement loosening was 14.29% in group PPP, and 0 in screw group (p < 0.05). CONCLUSION This 2-year follow-up study shows that the PVP-bone cement bridging screw system combined therapy had better midterm treatment efficacy than the PVP-PPP combined therapy in patients with unstable KD, and the bone cement bridging screw system is a preferred therapy with better anti cement loosening ability.
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Affiliation(s)
- Jie Guo
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yesheng Bai
- Pain Ward, Rehabilitation Hospital of Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Liang Li
- Pain Ward, Rehabilitation Hospital of Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Jiangtao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical School of Yan’an University, Yan’an, China
| | - Yuhang Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Dinghun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Kan DJ, Han DP, Wang JH, Wang LF, Shen Y. Efficacy and Safety of High-Viscosity Bone Cement in Percutaneous Vertebroplasty for Kummell's Disease. Indian J Orthop 2024; 58:575-586. [PMID: 38694703 PMCID: PMC11058172 DOI: 10.1007/s43465-024-01133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/02/2024] [Indexed: 05/04/2024]
Abstract
Background To analyze and evaluate the clinical outcomes of using high-viscosity bone cement compared to low-viscosity bone cement in percutaneous vertebroplasty (PVP) for treatment of Kummell's disease. Methods From July 2017 to July 2019, 68 Kummell's disease patients who underwent PVP were chosen and separated into 2 groups: H group (n = 34), were treated with high-viscosity bone cement and L group (n = 34), treated with low-viscosity bone cement during treatment. The operation time, number of fluoroscopy tests done, and amount of bone cement perfusion were recorded for both groups. Clinical outcomes were compared, by measuring their Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Kyphosis Cobb's angle, vertebral height compression rate, and other complications. Results High-viscosity group showed less operation time and reduced number of fluoroscopy tests than the low-viscosity group (P < 0.05). When compared to preoperative period, both groups' VAS and ODI scores were significantly reduced at 1 day and 1 year postoperatively (P < 0.05). The vertebral height compression rate and Cobb's angle were significantly lower (P < 0.05) in both groups after surgery compared with those before surgery (P < 0.05). The cement leakage rate in group H was 26.5%, which was significantly lower than that in group L, which was 61.8% (P < 0.05). Conclusions High-viscosity and low-viscosity bone cement in PVP have similar clinical efficacy in reducing pain in patients during the treatment, but in contrast, high-viscosity bone cement shortens the operative time, reduces number of fluoroscopy views and vertebral cement leakage and improves surgical safety.
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Affiliation(s)
- Dong-Jie Kan
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051 China
- Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, 81 Congtai Road, Handan, 056000 China
| | - Dong-Ping Han
- Department of Urinary Surgery, Affiliated Hospital of Hebei University of Engineering, 81 Congtai Road, Handan, 056000 China
| | - Jing-Huai Wang
- Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, 81 Congtai Road, Handan, 056000 China
| | - Lin-Feng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051 China
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Song KS, Yoon BI, Ham DW. Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series. World Neurosurg 2024; 184:119-124. [PMID: 38266993 DOI: 10.1016/j.wneu.2024.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. METHODS Six consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle, restoration ratio of anterior vertebral height of the index vertebra, and clinical outcomes including the Oswestry Disability Index, EuroQol 5-dimension instrument, and visual analog scale for back and leg pain, were compared between the preoperative and final follow-ups. RESULTS All patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative restoration ratio of anterior vertebral height was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative local kyphosis angle was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. CONCLUSIONS Expandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's end plates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
| | - Byung-Il Yoon
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Bae J, Ang CY, Syed I, Jeong SK, Shin SH, Lee SH. Minimally Invasive Surgery Transpedicular Intrabody Cage Technique for the Management of Kummell Disease. Int J Spine Surg 2024; 18:73-80. [PMID: 38320806 PMCID: PMC11265504 DOI: 10.14444/8570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The treatment of Kummell disease remains controversial, with a wide variety of options proposed in the literature. This study aims to introduce a unique and minimally invasive approach for the treatment of Kummell disease and present the clinical results of this technique. METHODS Twenty patients underwent surgery using the minimally invasive surgery transpedicular intrabody cage (MISTIC) technique from 2014 to 2016. Postoperatively, patients were seen at 3, 6, and 12 months after surgery. Visual analog scale and Oswestry Disability Index scores were collected, and patient outcomes were graded according to the modified MacNab's criteria. Radiological outcomes were assessed through measurements of the anterior vertebral height (AH), mean vertebral body height (BH), and segmental angle (SA) on standing lateral radiographs pre- and postoperatively. RESULTS There was significant improvement in the SA, AH, and BH postoperatively. The SA improved from 15.2 ± 8.7° of kyphosis to 1.2 ± 5.2° (P < 0.01) in the immediate postoperative period. The AH increased from 13.3 ± 14.6 to 22.6 ± 12.2 mm (P < 0.01), and at the final follow-up, it was 21.9 ± 12.6 mm (P < 0.01). Similarly, the BH increased from 18.5 ± 6.8 to 25.6 ± 7.6 mm (P < 0.01) postsurgery, and at the final follow-up, it was 23.6 ± 4.4 mm (P < 0.01). CONCLUSIONS The MISTIC technique offers significant correction of kyphosis and restoration of the vertebral anatomy following surgery. These results were maintained at 12 months postoperation, with a 100% union rate of the fractures. Additionally, patients experienced significant pain relief and improvement in their ODI scores that were maintained at 12 months. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Junseok Bae
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Chay-You Ang
- Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | | | - Seong Kyun Jeong
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Sang Ha Shin
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
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Chen C, Gao X, Li H, Pan X, Wang S. Intravertebral insertion of interbody fusion cage via transpedicular approach for the treatment of stage III Kümmell disease: a technical note and case presentation. Br J Neurosurg 2023; 37:1909-1914. [PMID: 33843392 DOI: 10.1080/02688697.2021.1892590] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Kümmell disease usually occurs in the elderly osteoporosis population and develops gradually into symptomatic, progressive kyphosis of the spine. However, current surgical methods to deal with stage III Kümmell disease are less satisfying. The objective of this study was to describe a less invasive technique for treating stage III Kümmell disease. TECHNIQUE A less invasive technique of intravertebral insertion of interbody fusion cage via transpedicular approach with posterior spine stabilization was applied to treat stage III Kümmell disease. RESULTS This study details a modified technique applied in a patient with stage III Kümmell disease, showing significant improvement in pain relief, anterior column height recovery, and kyphotic angle correction. And no complications were reported during our follow-up. CONCLUSIONS Intravertebral insertion of interbody fusion cage via transpedicular approach provides advantages of acceptable correction of kyphosis, bony fusion, minimal invasion. Thus, our method was a good alternative choice for stage III Kümmell disease.
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Affiliation(s)
- Changjun Chen
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xianlei Gao
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Hao Li
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Xin Pan
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
| | - Songgang Wang
- Department of Orthopaedics, Shandong University Qilu Hospital, Jinan, People's Republic of China
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Xue Y, Lun Z, Feng J, Dai W. Percutaneous Functional Spinal Unit Cementoplasty versus Posterior Spinal Fixation with Vertebroplasty for Symptomatic Chronic Osteoporotic Vertebral Fractures: A Retrospective Study with a 2-Year Follow up. J INVEST SURG 2023; 36:2257780. [PMID: 37852750 DOI: 10.1080/08941939.2023.2257780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To compare the clinical efficacy of percutaneous functional spinal unit cementoplasty (PFSUP) and posterior spinal fixation combined with vertebroplasty (PSF + VP) for the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVFs). METHOD Thirty-one patients with SCOVFs were included in this retrospective study and divided into PFSUP (n = 14) and PSF + VP (n = 17) groups. Visual analog scores (VAS) and Oswestry Disability Index (ODI) were recorded before and after surgery and at the last follow-up. Besides, the local kyphosis angle (LKA) and sagittal vertical axis (SVA) were measured. The operation duration, number of X-ray exposures, amount of blood loss, bed rest duration, hospitalization duration, and presence of complications were recorded. RESULT The VAS, ODI, LKA, and SVA after surgery and at the last follow-up were significantly improved in both groups compared to preoperative measurements. The PFSUP group experienced shorter operation duration (78.2 ± 13.1 vs. 124.7 ± 14.7, p < 0.001), less blood loss (31.1 ± 8.1 vs. 334.7 ± 70.9, p < 0.001), more X-ray exposures (92.1 ± 14.3 vs. 29.4 ± 5.5, p < 0.001), shorter bed rest duration (12.4 ± 3.8 vs. 43.4 ± 10.0, p < 0.001), shorter hospitalization (6.6 ± 2.4 vs. 10.9 ± 2.7, p < 0.001), lower complication rate (28.5% vs. 64.7%, p < 0.05), and higher cement leakage rate (42.9% vs. 5.8%, p < 0.05) than the PSF + VP group. CONCLUSION During the treatment of SCOVFs, the combination of PFSUP and PSF + VP can restore spinal stability, improve kyphosis, and relieve pain. PFSUP can reduce blood loss and complications, early mobilization, and shorten the hospital stay, but it is associated with a higher cement leakage rate and more radiation exposure.
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Affiliation(s)
- Youdi Xue
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Zhifa Lun
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Jie Feng
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Weixiang Dai
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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Chen H, Shi G, Chen M, Wang R. Double Vertebrae Kümmell Disease: Five Cases Report and Literature Review. Orthop Surg 2023; 15:2454-2463. [PMID: 37435837 PMCID: PMC10475666 DOI: 10.1111/os.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
Kümmell disease (KD) is a complication of osteoporotic vertebral compression fractures. There is a lot of literature on KD, but the reported cases are all single vertebrae. This study reports five double vertebrae KD cases (10 levels) and discusses the possible underlying mechanisms with a literature review. One hundred and thirty vertebrae KD were diagnosed from 2074 osteoporotic vertebral compression fractures patients treated in our hospital between 2015 and 2019. These vertebrae KD were divided into two groups, one-level vertebrae KD (n = 125) and double-level KD (n = 5). The diagnosis of KD is mainly based on the signs of intravertebral vacuum cleft on X-ray or CT scan. Double vertebrae KD cases were classified by using the KD staging system. The analysis was performed on KD to compare age, gender, femoral neck bone mineral density of femoral neck (BMD), vertebrae distribution, Cobb angle, and visual analog scale (VAS) between one-level KD and double-level by t-tests, Welch's t-test, or hypothesis testing. The mean age of the participants in the one-level KD group was 78.69 years, while the mean age in the double-level KD group was 82.4 years. The difference was statistically significant (t = 3.66, p = 0.0004). There were 89 females and 36 males in the one-level KD group, while the double-level KD group had five females and no males. The femoral neck BMD was significantly different between the two groups, with the one-level KD group having a mean BMD of -2.75 and the double-level KD group having a mean BMD of -4.2 (t = 2.99, p= 0.0061). The vertebrae distribution was different between the groups, with the one-level KD group having vertebrae from T7 to L4 and the double-level KD group having vertebrae from T11 to L1. The Cobb angle was also significantly different between the groups, with the one-level KD group having a mean angle of 20.58 and the double-level KD group having a mean angle of 31.54 (t = 6.22, p = 0.0001). Finally, the VAS scores were similar between the two groups, with the one-level KD group having a mean score of 8.63 and the double-level KD group having a mean score of 8.8 (t = 1.35, p = 0.1790). It is concluded that double vertebrae Kümmell disease has special clinical significance due to its potential to cause greater spinal instability and deformity, increased risk of neurological symptoms, more complex surgical management, and greater risk of complications.
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Affiliation(s)
- Hao Chen
- Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Guan Shi
- Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Mengmeng Chen
- Beijing Friendship HospitalCapital Medical UniversityBeijingChina
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12
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Zou D, Wang H, Zhao Y, Sun X, Du W. Evaluation of the clinical efficacy of the bilateral pedicle cement anchoring technique in percutaneous vertebroplasty for Kümmell disease. Exp Ther Med 2023; 26:391. [PMID: 37456159 PMCID: PMC10347174 DOI: 10.3892/etm.2023.12090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
The present study aimed to evaluate the clinical efficacy of the bilateral pedicle cement anchoring technique combined with the postural reduction in percutaneous vertebroplasty (PVP) for Kümmell disease. For this purpose, a retrospective study was performed on 18 patients with Kümmell disease who between January 2018 and June 2021 underwent bilateral pedicle cement anchoring combined with postural reduction in PVP. Pre- and post-operative bone mineral density, injected cement volume, visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements and anterior vertebral height (AVH) were recorded and assessed. The mean follow-up duration was 8.4±1.2 months. The average VAS score decreased from 8.17±0.71 pre-operatively to 1.56±0.62 post-operatively and remained at 2.00±0.91 at the final follow-up visit (P<0.05). The average ODI improved from 86.44±5.5 pre-operatively to 24.33±7.82 post-operatively. Until the last follow-up, the ODI remained at 27.11±8.76 (P<0.05). Similarly, the changes in the Cobb angle and AVH before and after surgery were also statistically significant in the radiological evaluation (P<0.05). During the follow-up, two patients experienced adjacent vertebral fractures. The loosening of cement was not found. Overall, the present study demonstrated that during the treatment of Kümmell disease with PVP, the bilateral pedicle cement anchoring technique combined with postural reduction can achieve good clinical outcomes.
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Affiliation(s)
- Dexin Zou
- Department of Spine Surgery, Yantaishan Hospital, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Huimin Wang
- Department of Spine Surgery, Yantaishan Hospital, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Yong Zhao
- Department of Spine Surgery, Yantaishan Hospital, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Xuri Sun
- Department of Spine Surgery, Yantaishan Hospital, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Wei Du
- Department of Spine Surgery, Yantaishan Hospital, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
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Kuppan N, Muthu S, Parthasarathy S, Mohanen P. Strategies in the Management of Osteoporotic Kummell's Disease. J Orthop Case Rep 2022; 12:34-38. [PMID: 36874888 PMCID: PMC9983383 DOI: 10.13107/jocr.2022.v12.i10.3356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Kummell disease is a condition characterized by severe pain, progressing kyphosis with or without neurological deficit following a trivial trauma in the old age osteoporotic population. It is an osteoporotic vertebral fracture due to avascular necrosis of the vertebra, having an asymptomatic period initially followed by progressive pain, kyphosis, and neurologic deficit. Although various management options are available for Kummell's disease, a dilemma occurs in selecting an optimal modality in each case. Case Report A 65-year-old female presented with complaints of low back pain for 4 weeks. She developed progressive weakness and bowel bladder disturbance. Radiographs showed a D12 vertebral compression fracture with an intravertebral vacuum cleft sign. Magnetic resonance imaging showed intravertebral fluid and significant compression of the cord. We performed posterior decompression, stabilization, and transpedicular bone grafting at the D12 level. Histopathology confirmed Kummell's disease. The patient recovered with restored power and bladder control and resumed independent ambulation. Conclusion Osteoporotic compression fractures are more prone to pseudoarthrosis due to poor vascular and mechanical support, they need adequate immobilization and bracing. Transpedicular bone grafting for kummels disease seems to be a good surgical option due to its short operating time, less bleeding, less invasive approach, and early recovery. However, a treatment-oriented classification is needed to treat this clinical entity on a case-by-case basis.
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Affiliation(s)
- Naveenkumar Kuppan
- Department of Orthopaedics and Spine surgery, Sree Manakula Vinayagar Medical College and Hospitals, Puducherry, India
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu, India.,Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sathyanarayanan Parthasarathy
- Department of Orthopaedics and Spine surgery, Sree Manakula Vinayagar Medical College and Hospitals, Puducherry, India
| | - Pragash Mohanen
- Department of Orthopaedics and Spine surgery, Sree Manakula Vinayagar Medical College and Hospitals, Puducherry, India
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Zhang X, Li ZX, Yin LJ, Chen H. Selective nerve block for the treatment of neuralgia in Kummell’s disease: A case report. World J Clin Cases 2022; 10:7523-7530. [PMID: 36158019 PMCID: PMC9353927 DOI: 10.12998/wjcc.v10.i21.7523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease, and its mechanism is complex, rendering it challenging to treat. Percutaneous kyphoplasty (PKP) has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes. However, it is not optimal for managing severely collapsed vertebrae, as cement injection may not be feasible. This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.
CASE SUMMARY In our patient, three vertebrae were involved. The collapse of T11 was particularly severe. After managing T8 and T9 using PKP, these two segments were effectively strengthened; consequently, back pain was significantly relieved. However, the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection. This caused obvious neuralgia according to the postoperative status of the PKP. Thus, we performed selective nerve blocks for the treatment of neuralgia, which resulted in satisfactory outcomes.
CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.
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Affiliation(s)
- Xin Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Zong-Xi Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Li-Jun Yin
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
- Department of Anesthesiology, Ningbo Women and Children’s Hospital, Ningbo 315012, China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, shanghai 200434, China
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15
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Wang Y, Liu B, Sun Z, Zhang Y, Su J. Comparative Efficacy of Three Minimally Invasive Procedures for Kümmell's Disease: A Systematic Review and Network Meta-Analysis. Front Surg 2022; 9:893404. [PMID: 35722530 PMCID: PMC9198435 DOI: 10.3389/fsurg.2022.893404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 12/25/2022] Open
Abstract
Background Percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and bone-filling mesh containers(BFC) are three viable minimally invasive techniques that have been used to treat Kümmell's disease(KD). However, there is still debate as to which is safer and more effective. This study summarized the pros and cons of the three techniques in the treatment of KD through network meta-analysis(NMA). Methods All eligible published clinical control studies comparing PVP, PKP, and BFC for KD up to December 2021 were collected by online search of Cochrane Library, PubMed, Embase, CNKI, Wanfang Database, and Chinese biomedical literature database. Data were extracted after screening, and Stata 16.0 software was used to perform the network meta-analysis. Results Four randomized controlled trials (RCTs) and 16 retrospective case-control studies (CCTs) with a total of 1114 patients were included. The NMA results showed no statistical difference between the 3 procedures in terms of improving patients' clinical symptoms. PKP was most likely to be the most effective in correcting kyphosis, while BFC was likely to be the most effective in managing the occurrence of cement leakage. No statistical differences were found in the incidence of new vertebral fractures in adjacent segments. Conclusions Ranking analysis showed that BFC has the highest likelihood of being the optimal procedure for the treatment of KD, based on a combined assessment of effectiveness in improving patients' symptoms and safety in the occurrence of adverse events.
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Affiliation(s)
| | | | | | - Yaning Zhang
- Department of Orthopedics, Linfen People's Hospital, Linfen, China
| | - Jiangping Su
- Department of Orthopedics, Linfen People's Hospital, Linfen, China
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16
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Zhang B, Chen G, Yang X, Fan T, Chen Z. Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Neurologically Intact Osteoporotic Kümmell's Disease: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:308-322. [PMID: 33541141 PMCID: PMC8907641 DOI: 10.1177/2192568220984129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive techniques widely used for the treatment of neurologically intact osteoporotic Kümmell's disease (KD), but which treatment is preferable remains controversial. Therefore, this study aimed to shed light on this issue. METHODS Six databases were searched for all relevant studies based on the PRISMA guidelines. Two investigators independently conducted a quality assessment, extracted the data and performed all statistical analyses. RESULTS Eight studies encompassing 438 neurologically intact osteoporotic KD patients met the inclusion criteria. Compared to PVP, PKP was associated with greater improvement in the short- and long-term Cobb angle [SMD = -0.37, P = 0.007; SMD = -0.34, P = 0.012], short-term anterior vertebral height [SMD = 0.43, P = 0.003] and long-term middle vertebral height [SMD = 0.57, P = 0.012] and a lower cement leakage rate [SMD = 0.50, P = 0.003] but produced more consumption (cement injection volume, operative time, fluoroscopy times, intraoperative blood loss and operation cost). However, there were no differences between the 2 procedures in the short- and long-term VAS and ODI scores, long-term anterior vertebral height, overall complications or new vertebral fractures. CONCLUSIONS Both procedures are equally effective for neurologically intact KD in terms of the clinical outcomes, with the exception of a lower cement leakage risk and better radiographic improvement for PKP but greater resource consumption. Based on the evidence available, good clinical judgment should be exercised in the selection of patients for these procedures.
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Affiliation(s)
- Baoliang Zhang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Guanghui Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiaoxi Yang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Tianqi Fan
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Zhongqiang Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Zhongqiang Chen, Orthopaedic Department,
Peking University Third Hospital, No. 49 North Garden Road, Haidian District,
Beijing 100191, China.
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17
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Mo GY, Zhou TP, Guo HZ, Li YX, Tang YC, Guo DQ, Luo PJ, Li DX, Yuan K, Mo L, Zhang SC. Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Sci Rep 2021; 11:13647. [PMID: 34211025 PMCID: PMC8249396 DOI: 10.1038/s41598-021-93013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
This study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. The average lumbar vertebral density T-value was - 3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis (SVA) were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56 ± 1.04, ODI: 77.80 ± 6.57%). Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.
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Affiliation(s)
- Guo-Ye Mo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Teng-Peng Zhou
- Guangdong Second Traditional Chinese Medicine Hospital, 60 Hengfu Road, Yuexiu District, Guangzhou, 510000, Guangdong, China
| | - Hui-Zhi Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yong-Xian Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yong-Chao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dan-Qing Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Pei-Jie Luo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dong-Xiao Li
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Kai Yuan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Ling Mo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shun-Cong Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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Gan DH, Fang MZ, Xue HP, Tan GQ, Li NH, Li ZC, Xu ZW. Clinical Observations of Kümmell Disease Treatment Through Percutaneous Fixation Combined with Vertebroplasty. Orthop Surg 2021; 13:1505-1512. [PMID: 34075704 PMCID: PMC8313159 DOI: 10.1111/os.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the safety and efficacy of percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of stage III Kümmell disease. METHODS The clinical data and follow-up results of 22 patients with Kümmell disease who were admitted to our department from 2014 to 2018 were analyzed. There were 14 females and eight males, and the Age range was 58-81 years. All patients were followed up for 24 months. The treatment method was percutaneous pedicle screw fixation combined with vertebroplasty. The patient general information such as age, gender, bedrest time and location of fracture vertebrae were recorded. The clinical symptoms and imaging data of visual analogue scale (VAS), bone cement leakage, Oswestry Disability Index (ODI), Cobb angle, anterior, middle and posterior height of the diseased vertebral body, and complications were recorded before operation and during follow-up. RESULTS For patients enrolled, no bone cement leakage was observed during the operation; no patients developed infections after operation. The operation was safe and resulted in a short bedrest time. The VAS score and ODI index at 3 and 24 months postoperative (2.86 ± 0.83, 31.68% ± 6.21%; 3.0 ± 0.82, 32.78% ± 6.05%) were significantly lower than that recoded preoperatively (7.59 ± 0.59, 71.5% ± 8.84%) (P < 0.05). Additionally, there was no significant difference between the records at 3 and 24 months after operation (P > 0.05). Imaging data showed that the bone cement and screws were in good position and did not move during postoperative and follow-up. The anterior, middle and posterior height of the diseased vertebral body measured 2 days after surgery (23.46 ± 4.72, 23.12 ± 3.05, 25.81 ± 2.22) and at last follow-up (20.83 ± 4.48, 21.78 ± 2.74, 24.74 ± 1.93) were higher than that recorded preoperatively (13.08 ± 4.49, 12.93 ± 3.53, 19.32 ± 2.73) (P < 0.05), and the Cobb angle measured 2 days and 24 months after operation (9.57 ± 4.63, 10.68 ± 3.97) were lower than that recorded preoperatively (28.24 ± 8.95) (P < 0.05), and no significant difference was found between the values recorded at 2 days and 24 months after operation (P > 0.05). Follow-up for 24 months, there was no re-fracture of the diseased vertebrae and internal fixation loosening, but two cases of adjacent vertebral refracture complications occurred, and the effect was good after PVP treatment. CONCLUSION Short-segment percutaneous pedicle screw fixation combined with vertebroplasty in the treatment of stage III Kümmel disease can effectively restore the height of the diseased vertebrae, kyphosis correction, reduce trauma, prevent the diseased vertebral body from collapsing again, and effectively improves clinical symptoms.
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Affiliation(s)
- Dong-Hao Gan
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng-Ze Fang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hai-Peng Xue
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guo-Qing Tan
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nian-Hu Li
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhi-Chao Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhan-Wang Xu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Wang X, Xu J, Kou J, Tian W, Gao C, Cui F, Qiu Z. The clinical results of treating Kummell's disease with mineralized collagen modified polymethyl methacrylate. J Biomater Appl 2021; 35:1366-1371. [PMID: 33554721 DOI: 10.1177/0885328221990821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To investigate the clinical results of treating Kummell's Disease by using mineralized collagen modified polymethyl methacrylate bone cement, 23 cases (23 vertebras) who sustained Kummell's Disease treated with mineralized collagen modified polymethyl methacrylate bone cement from July 2017 to February 2019 were reviewed retrospectively. The visual analogue scale, vertebral body height, Cobb angle, CT values pre-operation and post-operation as well as incidence of complications were observed. All the patients were successfully followed up with an average period of 11.3 months (ranging from 6 to 12 months). The patients could ambulate on the second day after the operation. The visual analogue scale scores significantly decreased from two days after the operation to the last follow-up compared with that before the operation (p < 0.05); the average vertebral height and local Cobb angle had significant recovery (p < 0.05); the CT value of the treated vertebra significantly increased compared with that before the operation (p < 0.05). Bone cement leakage occurred in one case, anterior edge leakage occurred in one case, and no clinical symptoms caused by bone cement leakage occurred. No re-fracture of the treated vertebral body or adjacent vertebral bodies were observed in the follow-ups. With good osteogenic activity and degradable absorption characteristics, mineralized collagen was compounded with the existing polymethyl methacrylate bone cement to reduce its strength in the vertebral body and enhance biocompatibility, the incidence of adjacent vertebral fractures and re-fractures within the injured vertebrae is significantly reduced, and good clinical results are obtained, which is worthy of popularization.
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Affiliation(s)
- Xi Wang
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Jin Xu
- Department of Basic Medicine, Kangda College of Nanjing Medical University, Lianyungang, China
| | - Jianming Kou
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Wei Tian
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Chong Gao
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Fuzhai Cui
- School of Materials Science and Engineering, Tsinghua University, Beijing, China.,R&D Department, Allgens Medical Technology Corporation, Beijing, China
| | - Zhiye Qiu
- School of Materials Science and Engineering, Tsinghua University, Beijing, China.,R&D Department, Allgens Medical Technology Corporation, Beijing, China
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20
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Dai SQ, Qin RQ, Shi X, Yang HL. Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell's disease. BMC Surg 2021; 21:65. [PMID: 33514359 PMCID: PMC7846985 DOI: 10.1186/s12893-021-01057-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell's disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. METHODS The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb's angle were assessed by imaging. RESULTS All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. CONCLUSION PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.
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Affiliation(s)
- Shou-Qian Dai
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.,Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Rong-Qing Qin
- Department of Spinal Surgery, Gaoyou Hospital Affiliated Soochow University, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China.,Department of Orthopedics, Gaoyou People's Hospital, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China
| | - Xiu Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Hui-Lin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.
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Wang B, Wang Y, Zhang H, Yan L, Kong L, He S, Hao D. A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at the vertebral anterior border: A minimum 3-year follow-up study. Clin Neurol Neurosurg 2020; 201:106434. [PMID: 33370625 DOI: 10.1016/j.clineuro.2020.106434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES When vertebroplasty is used to treat Kummell disease with bone deficiency at the vertebral anterior border, bone cement displacement often occurs intraoperatively or postoperatively. We designed and used a new bone cement screw system to avoid this serious complication. The purpose of this study was to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up. PATIENTS AND METHODS From January 2014 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at the vertebral anterior border were treated by vertebroplasty combined with a novel bone cement screw. Bone cement was released into the diseased vertebrae through the screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperatively or postoperatively displacement. All patients received surgery involving a unilateral technique, and only one screw was implanted in each patient. The clinical efficacy was evaluated using Odom's criteria and statistical analysis of the vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), Oswestry disability index (ODI), and the results of the MOS 36-item short form health survey (SF-36). RESULTS The operation was completed successfully in 27 cases. The average operation time was 49.63 ± 10.82 min, and the average volume of cement injected was 4.70 ± 0.87 mL. The patients' preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11 ± 5.94, 21.04 ± 2.55, 45.00 ± 6.26, 7.59 ± 0.84, and 79.85 ± 7.58, respectively. The postoperative measurements were 78.70 ± 2.55, 12.70 ± 2.11, 26.11 ± 4.73, 3.22 ± 0.93 and 50.04 ± 9.28, respectively. At the last follow-up, the measurements were 78.04 ± 2.30, 13.15 ± 2.38, 27.07 ± 4.87, 2.04 ± 0.65, and 22.85 ± 5.06, respectively. There was a significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P < 0.05). Comparing the results of SF-36 before operation and at the last follow-up revealed significant differences in physical function, role-physical, body pain, vitality, and social function (P < 0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3 %) had good to excellent clinical outcomes according to Odom's criteria. CONCLUSIONS This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect in patients with Kummell disease and bone deficiency at the vertebral anterior border, while its long-term efficacy is subject to further studies.
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Affiliation(s)
- Biao Wang
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Yuhang Wang
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Haiping Zhang
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Liang Yan
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Lingbo Kong
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Simin He
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
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Wang B, Wang Y, Zhao Q, Zhao H, Zhang Y, Zhan Y, Yan L, Hao D. Pediculoplasty combined with vertebroplasty for the treatment of Kummell's disease without neurological impairment: robot-assisted and fluoroscopy-guided. Am J Transl Res 2020; 12:8019-8029. [PMID: 33437377 PMCID: PMC7791521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
With the development of radiology and minimally invasive technology, vertebroplasty has become the mainstream treatment for Kummell's disease. However, the catastrophic complication of bone cement displacement appears occasionally. We use robot-assisted pediculoplasty combined with vertebroplasty to avoid such complications. From January 2015 to January 2018, 87 patients suffering from thoracolumbar Kummell's disease without neurological symptoms were treated by robot-assisted pediculoplasty combined with vertebroplasty. Pediculoplasty as a "bridge" allows the bone cement at the anterior edge of the vertebral body to be fixed in the vertebral body through the intrapedicular cement, which can effectively prevent bone cement displacement. The clinical efficacy was evaluated based on the statistical analysis results of vertebral body index (VBI), Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) at 3, 6, 12, 18, and 24 months after treatment. The average operation time was 85.23±10.48 min, and the average volume of cement injected was 4.97±0.66 ml. The patients' preoperative VBI, Cobb angle, VAS and ODI scores were 62.01±11.32, 33.78±11.99°, 7.47±0.82, and 78.37±7.14, respectively. The postoperative measurements were 87.06±4.45, 16.57±6.46°, 2.89±0.95, and 46.91±8.44. At the last follow-up, the outcomes were 86.82±4.27, 16.72±6.22°, 1.75±0.69, and 20.48±4.48, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). The four evaluation indexes improved by 65.3%, 50.5%, 76.6%, and 73.9%, respectively. This 2-year follow-up study shows robot-assisted and fluoroscopy-guided pediculoplasty combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell's disease without neurological impairment. This technique effectively prevents cement displacement and achieves rapid pain relief, with satisfactory vertebral body height restoration, and kyphotic deformity improvement.
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Affiliation(s)
- Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Yuhang Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Qinpeng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - He Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Yongyuan Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China
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Dong C, Wei H, Zhu Y, Zhou J, Ma H. Application of Titanium Alloy 3D-Printed Artificial Vertebral Body for Stage III Kümmell's Disease Complicated by Neurological Deficits. Clin Interv Aging 2020; 15:2265-2276. [PMID: 33293803 PMCID: PMC7719306 DOI: 10.2147/cia.s283809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The current study aimed to compare the clinical and radiographic results of the 3D-printed artificial vertebral body (3DP-AVB) and titanium mesh cage (TMC) for the treatment of Kümmell’s disease (KD) complicated by neurological deficits. Patients and Methods From January 2014 to July 2018, 28 consecutive patients diagnosed with KD and nerve injuries in our department were treated by posterior vertebral column resection and internal fixation. The patients were divided into two groups (3DP-AVB group and TMC group) based on the different anterior column reconstruction implants. Clinical and radiographic parameters were used to evaluate the outcomes. Results The two groups achieved excellent clinical and radiographic results 1 month after surgery with no significant difference (P>0.05), while 3DP-AVB group showed better outcomes compared with TMC group during the follow-up after 6 months (P<0.05). The risk of subsidence in 3DP-AVB group was lower than that in TMC group (41.6% vs 87.5%, P<0.05), and severe subsidence (≥5 mm) was correlated with the recurrence of back pain and bad daily life function. No significant difference was found in the improvement of neurological function between the two groups (P>0.05). The blood loss and operation time in 3DP-AVB group were significantly less than both in TMC group (P<0.05). Conclusion The lower incidence of cage subsidence, with a better long-term efficacy in maintaining the height of the fused segment, relieving back pain, and improving daily life function indicates that the 3DP-AVB may be a superior alternative for KD with neurological deficits.
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Affiliation(s)
- Chunke Dong
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People's Republic of China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, Beijing 101100, People's Republic of China
| | - Jun Zhou
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
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Dong L, Dong C, Zhu Y, Wei H. Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review. BMC Musculoskelet Disord 2020; 21:619. [PMID: 32948151 PMCID: PMC7501658 DOI: 10.1186/s12891-020-03642-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Among common findings in osteoporotic vertebral compression fractures (OVCFs), the intravertebral cleft (IVC) is usually considered a benign lesion. The current study was aimed to present a rare case of vertebral fracture caused by IVC-related spinal tuberculosis. Case presentation A 73-year-old female complained of back pain and weakness in lower limbs for 2 weeks. 3 months ago, after a minor trauma, she got back pain without weakness in lower limbs. Initially, she was diagnosed with a L1 compression fracture and accepted conservative treatment. After an asymptomatic period, she complained progressive pain at the fracture position with weakness of both lower limbs and was referred to our hospital with suspicion of Kümmell’s disease. The patient underwent posterior debridement and internal fixation for decompression and stabilization of the spine. Pathological examinations revealed the patient with spinal tuberculosis. Conclusions Although IVC is common in patients with OCVFs, there are some cases believed to be found in patients with spinal tuberculosis or infection. Further test, like CT-guided puncture biopsy, may be required before decisive treatment when an IVC is observed.
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Affiliation(s)
- Liang Dong
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, YouYi East road, Xi'an, 710054, China.
| | - Chunke Dong
- Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Wang W, Liu Q, Liu WJ, Li QB, Cai L, Wang ZK. Different Performance of Intravertebral Vacuum Clefts in Kümmell's Disease and Relevant Treatment Strategies. Orthop Surg 2020; 12:199-209. [PMID: 32077262 PMCID: PMC7031591 DOI: 10.1111/os.12609] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives This study aimed to present the different pattern of intravertebral vacuum cleft (IVC) related to high risk of cement complications in minimally invasive treatments for Kümmell's disease (KD) and relevant treatment strategies. Methods A retrospective study from January 2016 to January 2018 was conducted at Wuhan Fourth Hospital and comprised 35 patients with Kümmell's disease. There were seven males and 28 females, and the mean age of the patients was 70.4 years. The patterns of IVC in KD were analyzed. These patients were divided into three groups based on the treatment method used. The treatment methods included long‐segment fixation (LSF), posterior short‐segment fixation (SSF), and percutaneous kyphoplasty (PKP). We retrospectively reviewed outcomes, including the Oswestry Disability Index (ODI), visual analog scale (VAS) score, anterior height of affected vertebrae, kyphotic Cobb angle, and complications. Results All patients were followed up for 12–38 months. According to their radiographic appearance we could observe two main patterns of clefts. Pattern I, clefts that were found to be near to the endplate and connected with intervertebral space, the endplate was incomplete. Pattern II, IVC traversed to anterior edge of the vertebral body affected. Both were related to high risk of cement complications in minimal invasive treatments for KD. Good results have been achieved in LSF and SSF groups, the VAS, ODI, anterior height of affected vertebrae and kyphotic Cobb angle showed statistically significant differences between pre‐ and post‐operation and between pre‐ and final follow‐up (P < 0.05). In PKP group, although the VSA and ODI showed statistically significant differences between pre‐ and post‐operation and between pre‐ and final follow‐up (P < 0.05), we could observe that the VSA and ODI rebounded a little at the final follow‐up. Cement leakage into intervertebral space occurred in four (44.45%) patients of PKP group. Conclusions PKP should be chosen carefully if the IVC of the patient presents to be pattern I or II. LSF and SSF are safe and effective, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in patient's daily life, with few complications.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Liu
- Department of Plastic and Cosmetic, Wuhan Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei-Jun Liu
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing-Bo Li
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lei Cai
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zheng-Kun Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhao P, Guo A, Tan Z, Li T, Zhao F, Li J, Yan W. The evaluation of the treatment for old osteoporotic vertebral compression fracture pain by percutaneous vertebroplasty. Medicine (Baltimore) 2020; 99:e20479. [PMID: 32629631 PMCID: PMC7337473 DOI: 10.1097/md.0000000000020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to evaluate the clinical effect of percutaneous vertebroplasty (PVP) in the treatment of old osteoporotic vertebral compression fracture (OVCF) pain.A retrospective study was conducted on the clinical and imaging data of 31 patients with old OVCF treated by PVP from June 2010 to September 2011. Clinical efficacy was evaluated by the visual analog scale (VAS) scores, the oswestry disability index (ODI), the Cobb angle, and vertebral kyphotic angle at pre-operation and post-operation 3 days, 3 months, and 12 months.The VAS scores and ODI scores of 3 day, 3 month, and 12 month after PVP were significantly improved compared with those before operation (P < .05), but the Cobb angle and vertebral kyphosis angle were not significantly improved compared with those before operation (P > .05).PVP can effectively relieve the pain caused by old OVCF, and the motor ability of the patients is improved obviously. However, the recovery of Cobb angle and vertebral kyphosis angle was not obvious.
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Affiliation(s)
- Peng Zhao
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
| | - Aifeng Guo
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
| | - Zhongjiang Tan
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
| | - Tianqiang Li
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
| | - Fei Zhao
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
| | - Jie Li
- Department of Spine Surgery, the Second Hospital of Tangshan, Tangshan City, Hebei Province, China
| | - Wenliang Yan
- Department of orthopedics, Feixian People's Hospital, Linyi City, Shandong Province
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Application of Anchoring Technique in Unilateral Percutaneous Vertebroplasty for Neurologically Intact Kümmell's Disease. Pain Res Manag 2020; 2020:4145096. [PMID: 32566060 PMCID: PMC7267855 DOI: 10.1155/2020/4145096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 12/02/2022]
Abstract
Purpose We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell's disease. Methods From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell's disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P < 0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P < 0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell's disease.
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Yu H, Li Y, Yao X, Lin J, Pan Y, Zhuang H, Wang P. Application of percutaneous vertebroplasty and percutaneous kyphoplasty in treating Kümmell’s patients with different stages and postural correction status. Expert Rev Med Devices 2020; 17:357-364. [PMID: 32125194 DOI: 10.1080/17434440.2020.1736039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Haiming Yu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yizhong Li
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xuedong Yao
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jinkuang Lin
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yuancheng Pan
- Department of Orthopedics, The Second Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Huafeng Zhuang
- Department of Orthopedics, The Second Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Peiwen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Tsai SH, Liang CH, Chen KH, Pan CC, Lu WH, Lee CH. Novel, safe, and easy spinal osteotomy for regional kyphotic deformities. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:144-148. [PMID: 32254029 DOI: 10.5152/j.aott.2020.02.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy and safety of a newly developed transpedicular, anterior open-wedge osteotomy procedure with lamina preservation to correct sagittal imbalance in regional kyphotic deformities following compression fractures. METHODS All seven patients [four females and three males; mean (range) age, 67 (56-78) years] included in this study underwent surgery between May 2005 and May 2016 for symptomatic, rigid kyphosis secondary to compression fractures. Transpedicular, anterior open-wedge osteotomy with lamina preservation was performed in all patients using an osteotome to create a transverse fracture in the vertebral body through bilateral pedicles and an anterior open-wedge space filled with compacted bone graft to correct kyphosis. Pre- and post-operative kyphotic Cobb angles were evaluated, and the volume of intra-operative blood loss was measured. RESULTS The pre- and post-operative kyphotic Cobb angle was 35.3° and 17.7°, respectively (p<0.01); mean angle correction was 17.6° (p<0.05). No patient developed any complication with neurologic injury. Mean blood loss was 771 mL. Callus formation viewed on plain film was evident in all patients and was accompanied by decreased thoracolumbar back pain. CONCLUSION Transpedicular, anterior open-wedge osteotomy with lamina preservation is an easy and safe spinal osteotomy procedure for the correction of regional, fixed kyphotic deformities. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Shang-Hsuan Tsai
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Che-Han Liang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Hsien Lu
- Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Biotechnology, Hung-Kuang University, Taichung, Taiwan
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Guo D, Yu M, Zhang S, Tang Y, Tian Y, Li D, Mo G, Li Y, Guo H, Luo P, Zhou T, Ma Y, Abdukodir Y, Liu P, Liang D. Novel Surgical Strategy for Treating Osteoporotic Vertebral Fractures with Cord Compression. Orthop Surg 2019; 11:1082-1092. [PMID: 31750626 PMCID: PMC6904606 DOI: 10.1111/os.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/02/2019] [Accepted: 09/18/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Treatment for osteoporotic vertebral fracture (OVF) with cord compression is challenging and it usually requires surgical interventions to decompress nerves and restore spinal sequences. To describe a novel surgical strategy for treating OVFs with cord compression. METHODS This is a single-center retrospective analysis. The inclusion criteria were Frankel grade C-E, single level T10 -L2 . Between January 2008 and December 2016, a total of 56 OVF patients (47 females and nine males, with an average age of 72 years (66-88 years), comprising of eight grade C, 23 grade D, and 25 grade E patients) were enrolled. The treatment algorithm included preoperative evaluation by MRI, extension CT, and radiography to classify the OVFs as type 1.1 (reducible, stable; n = 13), type1.2 (reducible, unstable; n = 16), type 2 (irreducible; n = 19) or type 2M (modifier; n = 8). Vertebroplasty (VP)/kyphoplasty (KP) was applied in type 1.1. VP/KP with posterior fixation and posterolateral fusion was applied in type 1.2. And additional laminectomy/osteotomy was used in type 2, except in a modifier group (2M) where same procedure as applied for type 1.2 was used. VAS, ODI, Cobb angle, Frankel functional grade, and complications were recorded. RESULTS Thirteen cases were classified as type 1.1, 16 cases as type 1.2, 19 cases as type 2, and eight cases as type 2M. The follow-up period was 38.9 months (range, 24-108 months). All patients were followed-up in at least 24 months, in which time four patients died, two patients were lost at the last follow-up, and 50 patients completed the full study. The total VAS and ODI improved from 8 (7, 9) and 75.5% (67.2%, 80.0%) preoperatively to 2 (1, 3) and 31% (24.0%, 37.0%) on conclusion, respectively (P < 0.01). The local kyphotic angle was corrected from 22.3° (17.1°, 33. 8°) preoperatively to 10.4° (6.4°, 15.3°) on conclusion (P < 0.01). Twenty-three patients had achieved neurological recovery on conclusion (42E, 8D, P < 0.01). Asymptotic cement leakage was observed in 17/56 cases (30.4%), 6/56 in the affected vertebra (10.7%), and 24/330 in the screw trajectory (7.3%). At 2 years postoperatively, 11 new VFs had occurred in nine patients (16.1%), including VFs in nine adjacent segments that all occurred within 1 year after surgery. No cement migration or implant failure was noted. CONCLUSION The novel surgical strategy for treating OVFs with cord compression consists of the most tailored and least invasive treatment for each patient. The positive mid- and long-term clinical and radiological outcomes observed could represent a step forward in devising the proposed algorithm.
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Affiliation(s)
- Dan‐qing Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Miao Yu
- Spine Surgery DepartmentFoshan Hospital of Chinese MedicineFoshanChina
| | - Shun‐cong Zhang
- Spine Surgery Department1st Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yong‐chao Tang
- Spine Surgery Department1st Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yun Tian
- Orthopaedic DepartmentPecking University 3rd HospitalBeijingChina
| | - Da‐xing Li
- Orthopaedic DepartmentOrthopaedic Hospital of Guizhou ProvinceGuiyangChina
| | - Guo‐ye Mo
- Spine Surgery Department1st Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yong‐xian Li
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐zhi Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Pei‐jie Luo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Teng‐peng Zhou
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yan‐huai Ma
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yusupov Abdukodir
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Pan‐jie Liu
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - De Liang
- Spine Surgery Department1st Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
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Chen H, Yang J, Hao D. [Effectiveness of posterior short-segmental fixation with bone cement augmentation for stage Ⅲ Kümmell's disease with spinal canal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:707-711. [PMID: 31197997 PMCID: PMC8355774 DOI: 10.7507/1002-1892.201902001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/10/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of posterior short-segmental fixation with bone cement augmentation in treatment of stage Ⅲ Kümmell's disease with spinal canal stenosis. METHODS Between June 2012 and January 2017, 36 patients with stage Ⅲ Kümmell's disease and spinal canal stenosis were treated by posterior short-segmental fixation and bone cement augmentation. There were 12 males and 24 females, aged 55-83 years (mean, 73.5 years). The disease duration ranged from 2 to 8 months, with an average of 4.6 months. Preoperative bone mineral density examination showed that all patients had different degrees of osteoporosis in the spines. The lesion segments included T 10 in 4 cases, T 11 in 7 cases, T 12 in 8 cases, L 1 in 9 cases, and L 2 in 8 cases. The preoperative neural function was classified as grade B in 4 cases, grade C in 12 cases, grade D in 13 cases, and grade E in 7 cases according to Frankle classification. The operation time, intraoperative blood loss, and the volume of injected bone cement, and hospital stay were recorded. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), kyphotic Cobb angle, and the height of anterior edge of injured vertebra were recorded before operation, at 1 week after operation, and at last follow-up; and the leakage of bone cement was observed. RESULTS All operations were completed successfully. The operation time was 90-145 minutes (mean, 110.6 minutes); the intraoperative blood loss was 198-302 mL (mean, 242.5 mL); the volume of injected bone cement was 8.3-10.5 mL (mean, 9.2 mL); the hospital stays were 7-12 days (mean, 8.3 days). All patients were followed up 12-26 months (mean, 24.5 months). At 1 week after operation, the neural function was classified as grade B in 2 cases, grade C in 8 cases, grade D in 12 cases, and grade E in 14 cases, which was significantly improved when compared with that before operation ( Z=2.000, P=0.047). The VAS score, ODI, the height of anterior edge of injured vertebra, and Cobb angle were significantly improved at 1 week and last follow-up when compared with preoperative values ( P<0.05); but there was no significant difference between 1 week and last follow-up ( P>0.05). Two cases had asymptomatic cement leakage to the intervertebral disc at 1 week after operation; and 1 case had adjacent vertebral fracture at 8 months after operation. No complication such as loosening or breaking of internal fixator occurred during the follow-up. CONCLUSION Posterior short-segmental fixation with bone cement augmentation is a safe and effective surgical scheme for stage Ⅲ Kümmell's disease combined with spinal canal stenosis, which can avoid the aggravation of nerve injury and complications related to staying in bed.
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Affiliation(s)
- Hao Chen
- Xi'an Medical University, Xi'an Shaanxi, 710021, P.R.China;Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junsong Yang
- Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
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Duan ZK, Zou JF, He XL, Huang CD, He CJ. Bone-filling mesh container versus percutaneous kyphoplasty in treating Kümmell's disease. Arch Osteoporos 2019; 14:109. [PMID: 31741066 PMCID: PMC6861350 DOI: 10.1007/s11657-019-0656-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/25/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Kümmell's disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies. PURPOSE To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell's disease. METHODS From August 2016 to May 2018, 40 patients with Kümmell's disease were admitted to Guizhou Provincial People's Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb's angle changes, and related complications were recorded. RESULTS All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb's angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically. CONCLUSIONS Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell's disease. Moreover, the BMFC may prevent cement leakage.
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Affiliation(s)
- Z.-K. Duan
- Department of Pain, Guizhou Provincial People’s Hospital, Zhongshan Road, Guiyang, 550002 Guizhou China
| | - J.-F. Zou
- Department of Pain, Guizhou Provincial People’s Hospital, Zhongshan Road, Guiyang, 550002 Guizhou China
| | - X.-L. He
- Department of Pain, Guizhou Provincial People’s Hospital, Zhongshan Road, Guiyang, 550002 Guizhou China
| | - C.-D. Huang
- Department of Pain, Guizhou Provincial People’s Hospital, Zhongshan Road, Guiyang, 550002 Guizhou China
| | - C.-J. He
- Department of Pain, Guizhou Provincial People’s Hospital, Zhongshan Road, Guiyang, 550002 Guizhou China
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Kim HS, Adsul N, Bang JS, Singh R, Park CH, Jang IT. Refracture of Kummell Disease Combined with Huge Epidural Hematoma After Minor Trauma. World Neurosurg 2018; 120:500-505. [PMID: 30266694 DOI: 10.1016/j.wneu.2018.09.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kummell disease is defined as avascular necrosis of vertebra, occurs after the delayed posttraumatic osteoporotic vertebral collapse, and mainly occurs in adults older than 50 years of age. We report the first case of refracture of Kummell disease and epidural hematoma followed by paraparesis. CASE DESCRIPTION A 67-year-old woman with a known case of osteoporotic T12 fracture (3 months back) visited our outpatient clinic complaining of persistent back pain and paraparesis after jerking while getting up from the bed. Her neurology worsened suddenly in the next 2 days. A physical examination revealed grade 3 power in lower extremities with a lower extremity paresthesia and diminished bilateral knee and ankle reflexes. Urinary retention was also present. A plain radiographic examination of her thoracolumbar spine revealed osteoporotic compression fractures with almost 50% reduction in height of the 12th thoracic vertebra. Magnetic resonance imaging showed dorsal epidural soft tissue mass that caused posterior compression of the spinal cord at the T12-L3 levels. We performed thoracic lateral retropleural corpectomy and cage insertion at T12. Bone cement-augmented pedicle screw fixation was performed at the T10, T11, and L1 levels with laminectomy and decompression of hematoma at the T12, L1, L2, and L3 levels as a stage 1 procedure. CONCLUSIONS Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures. Periodic follow-up and treatment are essential for preventing tragic neurologic impairment.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Jung Soo Bang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Chang Hwan Park
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea; Medical School, University of Debrecen, Debrecen, Hungary
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
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Transpedicular Intrabody Cage Insertion with Posterior Spine Stabilization in Kümmell Disease: Report of 2 Cases. World Neurosurg 2018; 116:236-240. [DOI: 10.1016/j.wneu.2018.05.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/14/2022]
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Liu F, Chen Z, Lou C, Yu W, Zheng L, He D, Zhu K. Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:283-288. [PMID: 29803679 PMCID: PMC6146012 DOI: 10.1016/j.aott.2018.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/29/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review of literature comparing the clinical effectiveness and safety between anterior reconstruction (AR) and posterior osteotomy (PO) in the treatment of Kümmell's disease with neurological deficits. METHODS We systematically reviewed the literature in PubMed, EMBASE, Cochrane Database of Systematic Reviews, and the Web of Science for "spin*," "surg*," "Kümmell's disease," "Kummell's disease," "Kummell disease," "vertebral osteonecrosis," "vertebral pseudarthrosis," "intravertebral vacuum cleft," "delayed vertebral collapse," and "compression fracture nonunion". Quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation method. RESULTS A total of 10 publications involving 268 Kümmell's disease patients with neurological deficits were included in this review, with 7 studies of low- or very low-quality. There were 37.7% and 62.3% of patients receiving AR and PO, respectively. For clinical outcomes, AR group showed no significant differences in pain, neurological dysfunction, and imaging outcome improvements compared with patients who underwent PO. However, the incidence of implant-related complications including loose screw, screw fracture, screw disconnection, and plate dislodgment, was higher in AR group compared with PO group (21.6% vs. 14.3%). As another major complication, AR group more often required a second surgery. CONCLUSION This systematic review demonstrated that both AR and PO could improve pain, neurological dysfunction and imaging outcomes. However, serious comorbidities, multilevel corpectomies and/or severe osteoporosis highly required PO. Design discrepancies were found in the current studies, further higher-quality studies are warranted. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Feijun Liu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Zhenzhong Chen
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Chao Lou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Weiyang Yu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Lin Zheng
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Dengwei He
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Kejun Zhu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
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Lee K, Adsul N, Kim HS, Pee YH, Lee KL, Jang IT. Percutaneous Pedicle Screw Fixation with Bone Cement Augmentation Under Epidural Anesthesia for Treatment of Kümmell Disease in Extremely Old Age. World Neurosurg 2018; 119:506-510. [PMID: 29929027 DOI: 10.1016/j.wneu.2018.06.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In cases of Kümmell disease without neurologic deficit, percutaneous vertebroplasty or kyphoplasty has achieved short-term favorable outcomes. In the long term, recollapse of the augmented vertebral body and aggravation of kyphosis at the index level is often reported. Owing to medical comorbidities, elderly patients are often unsuited for extensive open spine surgery under general anesthesia. CASE DESCRIPTION A 95-year-old man presented with a 1-month history of intractable back pain and gait disturbance. Magnetic resonance imaging revealed intravertebral avascular necrosis with fluid collection at the L4 vertebra. After postural reduction using a pillow in the supine position for 2 days, percutaneous pedicle screw fixation with bone cement augmentation was performed at the L3-5 level including L4 fracture under epidural anesthesia. Additional posterior column compression was performed to achieve restoration of spinal canal and lumbar lordosis. Severe back pain was reduced after surgery, and the patient was able to walk the day after surgery. CONCLUSIONS To our knowledge, this is the first case of Kümmell disease in an extremely elderly patient in whom good clinical result was obtained after postural reduction, vertebral augmentation, and short segment percutaneous pedicle screw fixation under epidural anesthesia.
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Affiliation(s)
- Keun Lee
- Department of Neurosurgery, Nanoori Juan Hospital, Incheon, Republic of Korea
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.
| | - Yong-Hun Pee
- Department of Neurosurgery, Nanoori Juan Hospital, Incheon, Republic of Korea
| | - Kwang Lae Lee
- Department of Rehabilitation Medicine, Hyomin Care Hospital, Incheon, Republic of Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
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What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature. Asian Spine J 2018; 12:586-599. [PMID: 29879789 PMCID: PMC6002160 DOI: 10.4184/asj.2018.12.3.586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.
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Di HX, Liu FY, Yang SD, Wang H, Yang DL, Ding WY. Short-segment fixation with a cement-augmented pedicle screw for Kummell disease: Case report. Medicine (Baltimore) 2017; 96:e8617. [PMID: 29390258 PMCID: PMC5815670 DOI: 10.1097/md.0000000000008617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Kummell disease is described as avascular necrosis of a vertebral body that occurred in a delayed fashion after a minor trauma. Anterior, posterior, and anterior-posterior approaches have been reported. Nevertheless, there is no standard treatment for patients with Kummell disease. PATIENT CONCERNS We reported a successful cement-augmented pedicle screw placement in a patient with Kummell disease. A 63-year-old woman with serious osteoporosis complained persistent back pain with progressive lower extremities weakness for almost 2 years. DIAGNOSES The diagnosis of Kummell disease was mainly depended on clinical symptoms and imaging examinations. INTERVENTIONS The application of a cement-augmented pedicle screw was designed to treat this illness. OUTCOMES The operation was successful without any complications. The patient stated that symptoms were obviously improved in 1 week after operation. LESSONS The application of a cement-augmented pedicle screw is an effective treatment option for Kummell disease.
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Affiliation(s)
- He-Xuan Di
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Feng-Yu Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Wang H, Ding W. Posterior Vertebral Column Resection Through Unilateral Osteotomy Approach for Old Lumbar Fracture Combined with Kummell Disease. World Neurosurg 2017; 109:147-151. [PMID: 28974411 DOI: 10.1016/j.wneu.2017.09.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Kummell disease is a clinical syndrome characterized by minor spinal trauma with a symptom-free period from months to years, followed by progressive painful kyphosis. Many surgical options for Kummell disease have been reported in the previous literature; however, no study has mentioned the surgical strategy for patients whose fractured vertebrae were severely compressed and only a slice of superior and inferior end plate was left. CASE DESCRIPTION Here we report the case of a 69-year-old woman who suffered persistent severe back pain since she slipped and fell 1 year before medical consult. The patient presented with constrained body posture and pressure pain on the thoracolumbar region. Visual analog scale pain under weight bearing was 90/100, and her Oswestry Disability Index score was 74%. Kummell disease was diagnosed on the basis of clinical presentation, trauma history, radiograph, computed tomography, and magnetic resonance imaging. We performed the posterior vertebral column resection through the unilateral osteotomy approach for the patient, and the clinical outcome and radiologic restoration were recorded. One year after the surgery, outpatient follow-up review revealed that the visual analog scale reduced to 10/100 and Oswestry Disability Index reduced to 13%. The posteroanterior and lateral radiograph in the standing position showed bony fusion was achieved at the osteotomy site. No pseudarthrosis or instrumentation-related failure occurred. CONCLUSION Posterior vertebral column resection through unilateral osteotomy approach is an effective method for patients with Kummell disease, especially when the fractured vertebrae compressed severely and only a slice of superior and inferior end plate was left.
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Affiliation(s)
- Hui Wang
- Third Hospital of HeBei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Wenyuan Ding
- Third Hospital of HeBei Medical University, Shijiazhuang, Hebei, P. R. China.
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Qian B, Hao D, Zheng Y, Qian L, Yang J, Li H, Li H. [Effectiveness comparison between two operations in treatment of unstable type Kümmell's disease]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:185-190. [PMID: 29786251 PMCID: PMC8458154 DOI: 10.7507/1002-1892.201608096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/21/2016] [Indexed: 12/22/2022]
Abstract
Objective To compare the effectiveness between short segmental fixation combined with vertebroplasty (SSF+VP) and short segmental pedicle screw fixation combined with bone graft (SSF+BG) in the treatment of unstable type Kümmell's disease so as to provide a reference for the selection of the surgical method. Methods Between March 2013 and February 2015, 48 patients with unstable type Kümmell's disease who were in accordance with the inclusive criteria were included in the study. SSF+VP were used in 25 cases (SSF+VP group) and SSF+BG in 23 cases (SSF+BG group). There was no significant difference in gender, age, disease duration, bone mineral density, fracture segment, and preoperative visual analogue scale (VAS), Oswestry disability index (ODI), and kyphotic Cobb angle between 2 groups ( P>0.05). The operation time and complications related to operation were recorded; the effectiveness was evaluated by VAS, ODI, and kyphotic Cobb angle. Results The operation time was (107.7±18.8) minutes in SSF+VP group and was (113.7±22.4) minutes in SSF+BG group, showing no significant difference between 2 groups ( t=-1.045, P=0.302). Bone cement leakage occurred in 6 cases of SSF+VP group, and incision delayed healing occurred in 1 case of SSF+BG group. All patients achieved bone graft fusion on X-ray films. The bone graft fusion time was (15.1±1.3) weeks in SSF+VP group and (15.7±1.8) weeks in SSF+BG group, showing no significant difference between 2 groups ( t=-1.361, P=0.180). The VAS, ODI, and kyphotic Cobb angle at immediate after operation and at last follow-up were significantly lower than preoperative ones ( P<0.05). The VAS, ODI, and kyphotic Cobb angle had no significant difference between at immediate and at last follow-up in SSF+VP group ( P>0.05). In SSF+BG group, VAS at last follow-up was significantly lower than that at immediate after operation ( P<0.05), but no significant difference was found in kyphotic Cobb angle and ODI ( P>0.05). SSF+VP group was significantly better than SSF+BG group in VAS at immediate after operation ( P<0.05), but SSF+BG group was significantly better than SSF+VP group at last follow-up ( P<0.05). There was no significant difference in kyphotic Cobb angle and ODI between 2 groups at immediate after operation and at last follow-up ( P>0.05). Conclusion SSF+BG can achieve satisfactory effectiveness in the treatment of unstable type Kümmell's disease, and it has the advantages of good bony healing, obvious improvement of pain, and low complication incidence when compared with SSF+VP.
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Affiliation(s)
- Bing Qian
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
| | - Yonghong Zheng
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Lixiong Qian
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junsong Yang
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Houkun Li
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Han Li
- Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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Yang DL, Yang SD, Chen Q, Shen Y, Ding WY. The Treatment Evaluation for Osteoporotic Kummell Disease by Modified Posterior Vertebral Column Resection: Minimum of One-Year Follow-Up. Med Sci Monit 2017; 23:606-612. [PMID: 28148908 PMCID: PMC5301956 DOI: 10.12659/msm.902669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to evaluate the clinical efficacy of modified posterior vertebral column resection (MPVCR) in treating osteoporotic Kummell disease. Material/Methods Between January 2013 and January 2015, 10 patients who were diagnosed with Kummell disease underwent MPVCR treatment, and their medical records were retrospectively collected. Every patient had follow-up for at least one year, with an average of 15 months. Clinical efficacy of MPVCR treatment was evaluated by kyphotic Cobb’s angle, Oswestry disability index (ODI) and visual analogue scale (VAS) score. Results Data analyses showed that operation time was 188.39±30.8 minutes, and blood loss was 860±130 mL with 600±200 mL of blood transfusions. VAS score decreased significantly after MPVCR surgery (p<0.001, Mann-Whitney U test). In addition, data analyses showed that postoperative ODI was less than preoperative ODI, which was a statistically significant difference (p<0.001, Mann-Whitney U test). X-ray radiograph showed that kyphotic Cobb’s angle was 45°±12° preoperatively, 10°±4° two weeks after surgery, and 15°±6° at last follow-up, indicating that Cobb’s angle after MPVCR surgery was significantly improved, compared to the preoperative scores (p<0.05, SNK-q test). Conclusions MPVCR surgery was an effective and safe surgical method to treat Kummell disease, especially for patients with kyphotic deformity and obvious nerve-oppressed symptoms. However, the long-term clinical effect still needs further studies.
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Affiliation(s)
- Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, Hebei, China (mainland)
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Liu FY, Huo LS, Liu S, Wang H, Zhang LJ, Yang DL, Ding WY. Modified posterior vertebral column resection for Kümmell disease: Case report. Medicine (Baltimore) 2017; 96:e5955. [PMID: 28151882 PMCID: PMC5293445 DOI: 10.1097/md.0000000000005955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Kümmell's disease is defined as delayed traumatic vertebral collapse disease in which patients develop a kyphosis after asymptomatic minor spinal trauma. Both anterior approach and posterior approach have been reported, however, there is no standard treatment for Kümmell's disease. PATIENT CONCERNS We described a successful modified posterior vertebral column resection in a patient with Kümmell's disease. A 65-year-old woman reported persistent back pain for almost three months. DIAGNOSES Kümmell's disease was diagnosed based on computer tomography (CT) and magnetic resonance imaging (MRI). INTERVENTIONS Modified posterior vertebral column resection combined with short-segment fixation was designed to treat this disease. OUTCOMES The procedure was successful without any complications. Patient reported that symptoms were obviously improved in one week after operation. LESSONS Modified posterior vertebral column resection combined with short-segment fixation is an effective treatment option for Kümmell's disease.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Li-Shuang Huo
- Department of Endocrinology, The Second Hospital of Hebei Medical University
| | - Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Li-Jun Zhang
- Department of Orthopaedics, The First Hospital of Shijiazhuang
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Cutler HS, Guzman JZ, Connolly J, Al Maaieh M, Skovrlj B, Cho SK. Outcome Instruments in Spinal Trauma Surgery: A Bibliometric Analysis. Global Spine J 2016; 6:804-811. [PMID: 27853666 PMCID: PMC5110339 DOI: 10.1055/s-0036-1579745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/20/2016] [Indexed: 02/08/2023] Open
Abstract
Study Design Literature review. Objective To identify outcomes instruments used in spinal trauma surgery over the past decade, their frequency of use, and usage trends. Methods Five top orthopedic journals were reviewed from 2004 to 2013 for clinical studies of surgical intervention in spinal trauma that reported patient-reported outcome instruments use or neurologic function scale use. Publication year, level of evidence (LOE), and outcome instruments were collected for each article and analyzed. Results A total of 58 studies were identified. Among them, 26 named outcome instruments and 7 improvised questionnaires were utilized. The visual analog scale (VAS) for pain was used most frequently (43.1%), followed by the Short Form 36 (34.5%), Frankel grade scale (25.9%), Oswestry Disability Index (20.7%) and American Spinal Injury Association Impairment Scale (15.5%). LOE 4 was most common (37.9%), and eight LOE 1 studies were identified (10.3%). Conclusions The VAS pain scale is the most common outcome instrument used in spinal trauma. The scope of this outcome instrument is limited, and it may not be sufficient for discriminating between more and less effective treatments. A wide variety of functional measures are used, reflecting the need for a disease-specific instrument that accurately measures functional limitation in spinal trauma.
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Affiliation(s)
- Holt S. Cutler
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Javier Z. Guzman
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - James Connolly
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Motasem Al Maaieh
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Branko Skovrlj
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States,Address for correspondence Samuel K. Cho, MD Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai5 East 98th Street, New York, NY 10029United States
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Sheng X, Ren S. Surgical techniques for osteoporotic vertebral collapse with delayed neurological deficits: A systematic review. Int J Surg 2016; 33 Pt A:42-8. [DOI: 10.1016/j.ijsu.2016.07.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 01/31/2023]
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An Effective Treatment Option for Kümmell Disease With Neurological Deficits: Modified Transpedicular Subtraction and Disc Osteotomy Combined With Long-Segment Fixation. Spine (Phila Pa 1976) 2016; 41:E923-E930. [PMID: 26825791 DOI: 10.1097/brs.0000000000001467] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To illustrate the technique of modified transpedicular subtraction and disc osteotomy combined with long-segment fixation for the treatment of Kümmell disease with neurologic deficits and to evaluate clinical and radiographic results of patients treated with the technique. SUMMARY OF BACKGROUND DATA Kümmell disease is a clinical condition in which patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal. Currently, for patients with neurological deficits, anterior decompression with bone grafting fusion, posterior decompression with pedicle subtraction osteotomy, or a combined anterior and posterior approach operation were used; however, there is no standard treatment and no single effective treatment for Kümmell disease. METHODS Between May 2009 and May 2012, we reviewed 12 patients experiencing Kümmell disease with neurological deficits who underwent modified transpedicular subtraction and disc osteotomy combined with long-segment fixation. Preoperative and postoperative Cobb angle, visual analog scale, Asia Spinal Injury Association, and sagittal balance were documented. The patients were followed up for 33 months on average. RESULTS The Cobb angles decreased from 43.33 ± 7.44° to 1.92 ± 2.74° (P < 0.01), the mean visual analog scale reduced from 7.17 ± 1.27° to 1.17 ± 1.03° (P < 0.01), and the sagittal vertical angle improved from 14.82 ± 3.56 cm to 5.15 ± 2.10 cm (P < 0.01). Kyphotic deformity was successfully corrected and solid fusion was achieved in all cases. Neurologic function of nine cases was improved to various degrees. CONCLUSION Modified transpedicular subtraction and disc osteotomy combined with long-segment fixation is an effective treatment option for Kümmell disease with neurological deficits. LEVEL OF EVIDENCE 4.
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Wang F, Wang D, Tan B, Dong J, Feng R, Yuan Z, Wang N. Comparative Study of Modified Posterior Operation to Treat Kümmell's Disease. Medicine (Baltimore) 2015; 94:e1595. [PMID: 26426639 PMCID: PMC4616816 DOI: 10.1097/md.0000000000001595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The present study aimed at examining the curative effect of modified posterior operation on treatment of Kümmell's disease. About 30 patients of Kümmell's disease with complete image and clinical data treated during June 2004 to July 2013 were conducted with anterior and posterior approaches, respectively. Kyphotic Cobb angle, fractured vertebra wedge angle, and the anterior and posterior heights of fractured vertebra were all measured through x-ray before and after operation, and the pain visual analog scale (VAS) was determined for evaluating the effect of operations. The injury and restoration of neurological function were assessed using Frankel classification. Patients in group A were treated with anterior operation, whereas group B was posterior operation. Postoperatively, VAS score, kyphotic Cobb angle, anterior vertebra height, and pathologic vertebra wedge angle were all significantly improved in patients with Kümmell's disease receiving modified posterior operation (group B). Similar results were also observed in patients with anterior operation. The improvement of VAS and correction rate of kyphotic Cobb angle indicated equivalent effects of posterior and anterior operations. Meanwhile, alleviated neurological function damage was observed in 2 groups. Relevant factor analysis illustrated that there was no significant correlation of the severity and improvement rate of pain symptoms with age, medical history, anterior and posterior vertebra heights, kyphotic Cobb angle, and pathological vertebra wedge angle. Compared with traditional anterior approach, modified posterior operation, adopting transpedicular vertebral body grafting combined with vertebral pedicle screw fixation, could produce equivalent effects on kyphosis correction, pain relief, and improvement of neurological function in patients with Kümmell's disease.
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Affiliation(s)
- Feng Wang
- From the Department of Spinal Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
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Abstract
Osteoporotic vertebral fractures are a frequently encountered clinical problem, and like other fractures, they may develop nonunion that can often go unrecognized. The aim of this study is to review the related articles reporting the osteoporotic vertebral fracture nonunion and discuss the radiological characteristics, diagnosis, and treatment of osteoporotic vertebral fractures.
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Matzaroglou C, Georgiou CS, Panagopoulos A, Assimakopoulos K, Wilke HJ, Habermann B, Panos G, Kafchitsas K. Kümmell's Disease: Clarifying the Mechanisms and Patients' Inclusion Criteria. Open Orthop J 2014; 8:288-97. [PMID: 25246995 PMCID: PMC4168653 DOI: 10.2174/1874325001408010288] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 12/23/2022] Open
Abstract
The three major causes of vertebral body collapse include infection, malignant neoplasia, and trauma and it may be difficult to distinguish between them, particularly in the presence of severe osteoporosis. In 1891, however, Dr Hermann Kümmell, further added another possibility of vertebral body crush; the delayed posttraumatic collapse. As originally described, this rare clinical entity includes patients, who after a trivial trauma and an asymptomatic clinical course they develop a progressive vertebral body collapse and a painful kyphosis. Although more than a century has passed from its initial description, only few cases have been reported in the literature, whereas the main pathologic eliciting event is still under investigation. As a consequence, great controversy exists regarding the discrete features of the clinical course, its radiographic appearance and the histopathological findings. To explain the time lag between the initial trauma and the occurrence of the vertebral collapse, the hypothesis of ischemic necrosis was advanced. Equation of Kümmell's disease with vertebral osteonecrosis, however, has wrongly led many authors to report cases of Kümmell's disease, even in the absence of history of spinal trauma. On the other hand, high coincidence of vertebral osteonecrosis and the pathognomonic radiographic finding of intravertebral vacuum cleft, has further added to the confusion. In this review we present an overview of the literature on Kümmell's disease, focusing on the different proposed eliciting mechanisms. We also highlight controversial subjects on clinical course, diagnosis and treatment of this entity, in an attempt to further clarify patients' inclusion criteria.
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Affiliation(s)
| | | | | | | | - Hans J Wilke
- Institute for Orthopedic Research and Biomechanics, University of Ulm, Germany
| | - Bjoern Habermann
- Department of Orthopaedics and Traumatology, Johannes Gutenberg University, Mainz, Germany
| | - George Panos
- Department of Internal Medicine, University of Patras, Greece
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Subpedicle decompression and vertebral reconstruction for thoracolumbar Magerl incomplete burst fractures via a minimally invasive method. Spine (Phila Pa 1976) 2014; 39:433-42. [PMID: 24384656 DOI: 10.1097/brs.0000000000000186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To evaluate the clinical and radiographical results. SUMMARY OF BACKGROUND DATA The evolution of posterior approach for burst fractures was from long-segment to short-segment and then to monosegmental fixation. Decompression of the spinal cord is performed by anterior or posterior approaches. The technique attempts to decompress the spinal cord by a paramedian subpedicle approach, and simultaneous vertebral reconstruction with pile-up titanium spacers (subpedicle decompression and body augmentation [SpBA]) was developed. METHODS Eighty patients with symptomatic single thoracolumbar Magerl incomplete burst fractures were included. After manual reduction, transpedicle body augmentation and shortsegment fixation (TpBA group) were performed in 38 patients and SpBA in 42 cases. The mean follow-up was 52.6 ± 18.7 (TpBA) and 42.1 ± 7.8 (SpBA) months, and the age was 57.9 ± 7.2 and 59.1 ± 8.3 years. Clinical and radiographical outcomes were analyzed. RESULTS The operation time was 66 ± 11 (TpBA) versus 34.5 ± 5.5 (SpBA) minutes. The initial anterior vertebral correction was 46.8 ± 12.2% (TpBA) versus 53.2 ± 15.0% (SpBA) (P = 0.03) and the final correction was 44.0 ± 10.8% versus 51.5 ± 15.3% (P = 0.01). Initial corrections of the lateral Cobb angle were 22.3° ± 2.6° versus 22.8° ± 2.7° and the final corrections were 19.1° ± 3.4° versus 20.5° ± 2.9°. The VAS score was 7.7 ± 1.2 versus 7.9 ± 1.2 preoperatively and 2.2 ± 0.7 versus 1.8 ± 0.6 (P = 0.02) at the final visit. Seventy-five patients maintained or recovered to Frankel grade E. Three patients in the TpBA group and 2 in the SpBA group improved from grade C to D. Technical complications included 1 root overstretch in the SpBA group and one incomplete decompression in the TpBA group. CONCLUSION SpBA is a safe and fast technique to treat Magerl incomplete burst fractures and leads to good clinical results. LEVEL OF EVIDENCE N/A.
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Abstract
The diagnosis of Kümmell's disease mainly depends on clinical and radiologic findings. However, these are not the gold standards for diagnosing this disease; bone biopsy is required. The authors performed modified bone biopsy and cement-filling techniques during kyphoplasty and investigated the feasibility and efficacy of kyphoplasty for the treatment of Kümmell's disease. This study included 28 patients (9 men and 19 women; average age, 71.9 years) with Kümmell's disease. All patients underwent the modified biopsy procedure and kyphoplasty with the modified cement-filling technique. Treatment efficacy was evaluated using visual analog scale pain scores, Oswestry Disability Index scores, vertebral height, and Cobb angles pre- and postoperatively and at final follow-up. All patients tolerated the procedure well and had immediate back pain relief after kyphoplasty. Biopsy examination revealed necrotic bone in 24 patients and sparse cancellous bone in 2; it was unsuccessful in 2 patients. No severe complication occurred in any patient. Two patients had cement leakage but no clinical symptoms. All efficacy measures were significantly better at the postoperative assessments than the preoperative assessments (P<.05) but were similar at the postoperative and final follow-up assessments. Kyphoplasty is a relatively effective and safe method for treating Kümmell's disease when modified techniques are performed to prevent cement leakage, and forceps biopsy can be used in the differential diagnosis of this condition.
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