Comparative Study of Modified Posterior Operation to Treat Kümmell's Disease

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.

Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review

“…Kashii et al 12 also reported no significant differences between the two operations in the estimated mean blood loss and mean duration of surgery. However, Wang et al 11 reported overtly longer operation time and slightly increased blood loss in AR compared with PO ( Table 1 ).…”

“…Only 3 cohort trials 11 , 12 , 13 compared AR and PO for clinical and radiological data. These studies all found no significant differences between the two procedures with respect to pain relief, neurological and function improvement ( Table 2 ).…”

“…), and all relevant articles were read in full. Stringent exclusion criteria were applied, finally, 10 articles 6 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 were considered eligible for the study, including 3 articles reporting results from cohort study, and 7 articles reporting results from case series ( Table 1 ). Among the 10 articles, 4 assessed AR, while 9 evaluated PO.…”

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit-A Nationwide Multicenter Study in Japan-

“…A majority of these studies focusing on surgical outcomes for OVF with neurological deficits were reported from Japan, a country with the most advanced aging society in the world. There are several studies from other countries such as China, France or Korea; however, the number of patients in their samples were small and studies with a large number of patients is limited [15][16][17] . There is one previous, large-scale, systematic review that included 596 OVF patients with delayed neurological deficit from 29 publications 9) .…”

Titanium mesh bone grafting combined with pedicle screw internal fixation for treatment of Ku[Combining Diaeresis]mmell disease with cord compression

“…In addition, the intervertebral cleft can heal through the bone graft. Wang et al [ 15 ] adopted transpedicular vertebral body grafting combined with vertebral pedicle screw fixation to treat patients with Kümmell disease. Compared with the traditional anterior approach, this modified posterior operation offers equivalent effects on pain relief, kyphosis correction, and improvements in neurological function.…”