Analysis of percutaneous kyphoplasty or short-segmental fixation combined with vertebroplasty in the treatment of Kummell disease

Yang

et al. 2021

Global Spine Journal

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.

Section: Introductionmentioning

confidence: 99%

Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Neurologically Intact Osteoporotic Kümmell’s Disease: A Systematic Review and Meta-Analysis

Zhang

Yang

et al. 2021

Global Spine Journal

“…Since Galiber et al [15] Due to the presence of IVC and pseudarthrosis, the injured vertebra of KD can flex during spinal flexion activities, which can widen the cracks in the vertebral body [22]. The partial correction of collapsed vertebral height and kyphosis can be achieved when the spine is extended.…”

Section: Resultsmentioning

confidence: 99%

Clinical observation of two bone cement distribution modes of percutaneous vertebroplasty in the treatment of thoracolumbar Kümmell’s disease

Xiao²,

et al. 2020

Preprint

Background In recent years, percutaneous vertebroplasty (PVP) has provided a new option for the treatment of Kümmell’s disease (KD). The purpose of this study is to study the differences in clinical characteristics, clinical efficacy and related complications between two types of bone cement distribution patterns in the PVP treatment of KD. Methods Retrospective analysis from January 2016 to February 2018 showed that 63 patients with KD who received PVP treatment were included in the study. According to X-ray distribution modes of bone cement after treatment, all patients were divided into blocky group (30 cases ) and spongy group (33 cases). Clinical features and disease severity Preoperatively of the two groups, and clinical efficacy and related complications postoperatively were compared between the two groups. Results There was no significant difference in gender, injured segment, VAS and ODI preoperatively between the two groups (all P > 0.05). The duration of disease, age, Cobb angle and vertebral compression rate preoperatively were significantly higher in the blocky group than in the spongy group (P < 0.05, respectively). The height of vertebral anterior margin and BMD were significantly lower in the blocky group than in the spongy group (P < 0.05, respectively). The two groups were followed for at least 24 months. There were no statistically differences in the follow-up time, operation time, intraoperative blood loss, number of fluoroscopy, bone cement leakage and adjacent vertebral fracture between the two groups (all P > 0.05). The amount of bone cement injected into the blocky group was significantly higher than that of the spongy group (P = 0.000). VAS score and ODI postoperatively of the two groups were significantly reduced at 1 day, 1 year and the last follow-up (all P = 0.000), and were maintained at the last follow-up. VAS score and ODI postoperatively decreased significantly in the spongy group compared with the blocky group (P = 0.000). The correction degrees of kyphosis and vertebral compression postoperatively in the two groups were significantly corrected, but gradually decreased over time (P < 0.05), and these correction degrees of the blocky group was significantly higher than that of the spongy group and the postoperative loss was also more serious. Conclusions The treatment of KD by PVP can effectively relieve pain, improve function, restore vertebral height and correct kyphosis. The disease in the blocky group was more serious than that in the spongy group. The amount of bone cement, correction degrees of postoperative kyphosis and vertebral compression were significantly higher in the blocky group than in the spongy group, but the postoperative loss was also more serious in the blocky group. However, for pain relief and functional recovery, the spongy group was superior to the blocky group. Therefore, the spongy distribution pattern should be formed during the injection of bone cement to obtain better therapeutic effect.

BMC Musculoskelet Disord

“…Due to the presence of pseudarthrosis in KD, the IVC and the cracks in the vertebral body can be widened during spinal stretch activities [24]. Partial correction of kyphosis and collapsed vertebral height can be obtained by posterior extension of the spine.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the effect of percutaneous vertebroplasty in the treatment of thoracolumbar Kümmell’s disease with or without bone cement leakage

Xiao

Bei²,

Yan

et al. 2021

Background Bone cement leakage is a major complication in the treatment of percutaneous vertebroplasty for Kümmell’s disease, and the focus of close attention during the surgery. The purpose of this article was to investigate the clinical outcomes of Kümmell’s disease treated by percutaneous vertebroplasty with or without bone cement leakage. Methods A total of 64 patients with Kümmell’s disease from December 2016 to February 2018 treated by percutaneous vertebroplasty were included in the study. After the treatment, 32 cases were respectively divided into two groups according to X-ray examination of bone cement leakage: leakage group and non-leakage group. Preoperative course, age, sex, bone mineral density, damaged segment, anterior vertebral height, vertebral compression rate, Cobb angle, visual analogue scale and Oswestry dysfunction index were compared between the two groups. After surgery, the amount of bone cement injected, operation time, adjacent vertebral refracture rate, visual analogue scale, Oswestry dysfunction index, the recovery value of vertebral anterior height and the improvement value of Cobb angle were compared between the two groups. Results The course, age and Cobb angle of the leakage group were significantly greater than those of the non-leakage group (P< 0.05, respectively). The height of anterior vertebral margin and bone mineral density in the leakage group were significantly lower than those in the non-leakage group (P< 0.05, respectively). The two groups were followed up for at least 24 months. The amount of bone cement injected was significantly greater in the leakage group than in the non-leakage group (P=0.000). Visual analogue scale and Oswestry dysfunction index of the two groups on the second day after surgery and at the last follow-up were significantly lower than these before surgery (P< 0.05, respectively), but there was no significant difference between the two groups. In the leakage group, the recovery value of the anterior edge height of the injured vertebra and the improvement value of the Cobb angle on the second day after surgery and at the last follow-up were significantly improved compared with the non-leakage group (P< 0.05, respectively). Conclusion Percutaneous vertebroplasty is an effective and minimally invasive treatment for Kümmell’s disease. The leakage group had longer course, older age, more serious kyphotic deformity, vertebral compression and osteoporosis, and higher amount of bone cement injected than these of the non-leakage group. However, there were not significant differences in the rate of adjacent vertebral refractures, visual analogue scale and Oswestry dysfunction index between the two groups. Therefore, the bone cement leakage does not affect the surgical effect.