Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Abstract

BackgroundThis study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease.Material/MethodsFrom June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification.ResultsThe VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient.ConclusionsBone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.

Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell diseaseLong-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease

“…There are alternative treatment strategies for stage III Kümmell disease, but consensus regarding which is most feasible and effective is lacking. For stage III patients with severe stenosis of the spinal canal and neurological symptoms, the objective of surgery is to relieve cord compression, eliminate spinal instability, and restore the sagittal balance of the spine [12,19] Many studies have suggested that the main factor contributing to delayed neurological deficits following vertebral collapse in the osteoporotic spine is instability at the fracture site, rather than mechanical compression of the spinal cord by bone fragments [25,26]. Therefore, maintaining spinal stability is important for treating stage III patients.…”

“…Various surgical strategies have been developed, including percutaneous kyphoplasty (PKP) or vertebroplasty (PVP), anterior-only, posterior-only, and combined anterior and posterior procedures [8][9][10]. For stages I and II Kümmell disease, adequate pain relief, vertebral body height restoration, and kyphosis correction are achieved with PKP and PVP [11][12]. However, stage III Kümmell disease patients with spinal canal stenosis, particularly with nerve damage, PKP or PVP are less effective, with a higher risk of cement leakage, and potential severe neurological damage.…”

Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease

“…The incidence of Kummell's disease is relatively low and nonsurgical treatments have usually been less effective. Hence, many surgeons have advised that Kummell's disease should be treated by operative intervention [8] . For the posterior vertebral wall rupture, combined with severe kyphotic deformity and neurological symptoms at stage III of Kummell's disease, open surgery is recommended [9] .…”

Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

“…Treatment of Kümmell's Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up Background Since Kümmell's disease was rst proposed by Hermann Kümmell in 1895,it has been gradually recognized and understood by spinal surgeons [1].With the aging of the population,Kümmell's disease,as a complication of OVCF [2][3][4][5],also shows increased incidence [6,7].At present,Kümmell's disease is de ned as ischemic necrosis of the vertebral body after minor spinal injury [5,6,8].As the disease progresses, the injured vertebra gradually collapse tend to become wedge shaped due to bone necrosis,followed by kyphosis deformity of the spine.Due to the collapse of the posterior wall of the vertebral body and instability of the injured vertebrae,some injured vertebrae are prone to secondary spinal stenosis,and lead to spinal cord compression and neurological symptoms.…”