Modified posterior vertebral column resection for Kümmell disease

Liu, Fengyu; Huo, Li-Shuang; Liu, Sen; Wang, Hui; Zhang, Lijun; Yang, Da-Long; Ding, Wenyuan

doi:10.1097/md.0000000000005955

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…PUVCR, a modified modification of VCR, exposes the vertebral body through a unilateral approach, removes half of the vertebral body and the upper and lower intervertebral discs, shortens the operation time, and reduces the blood loss while restoring the sagittal sequence of the spine [ 13 ]. Some studies suggest that PUVCR can completely decompress and effectively restore deformity in the treatment of old thoracolumbar fractures [ 1 , 13 , 14 ]. Nevertheless, there is a lack of effective biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs affect spinal biomechanics; there also remains debate as to the appropriate length of fixation.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

Han

Wang

et al. 2021

J Orthop Surg Res

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Background Regarding the repair of vertebral compression fractures, there is a lack of adequate biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs affect spinal biomechanics; there also remains debate as to the appropriate length of fixation. Methods A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery. Results Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 mPa in a lateral bending motion and minimum stress of 40.22 mPa in a lateral bending motion in the SVCR. Conclusion There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was most significant at the screw-rod junction and greatest at the ribcage–vertebral body interface, partly explaining the high probability of internal fixation failure and prosthesis migration in these two positions.

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Section: Discussionmentioning

confidence: 99%

Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

Han

Wang

et al. 2021

J Orthop Surg Res

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show abstract

“…PUVCR, a modi ed modi cation of VCR, exposes the vertebral body through a unilateral approach, removes half of the vertebral body and the upper and lower intervertebral discs, shortens the operation time, and reduces the blood loss while restoring the sagittal sequence of the spine [13]. Some studies suggest that PUVCR can completely decompress and effectively restore deformity in the treatment of old thoracolumbar fractures [1,13,14]. Nevertheless, there is a lack of effective biomechanical veri cation as to whether only half of the vertebral body and the upper and lower intervertebral discs has any effect on spinal biomechanics; there also remains debate as to the appropriate length of xation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Old Vertebral Compression Fracture With Kyphosis by Different Reconstruction Methods: a Finite Element Analysis

Han¹,

Wang²,

Wu³

et al. 2020

Preprint

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Background: In repair of vertebral compression fractures, there is a lack of effective biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs has any effect on spinal biomechanics; there also remains debate as to the appropriate length of fixation.Methods: A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery.Results: Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 MPa in a lateral bending motion, and a minimum stress of 40.22 MPa in a lateral bending motion in the SVCR.Conclusion: There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was greatest at the screw-rod junction and greatest at the ribcage–vertebral body interface, which partly explains the high probability of internal fixation failure and prosthesis migration in these two positions.

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“…Compared with the traditional anterior approach, this modified posterior operation offers equivalent effects on pain relief, kyphosis correction, and improvements in neurological function. Liu et al [ 16 ] performed bone graft and titanium mesh combined with short-segment fixation to treat this disease. The procedure was successful without any complications.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Rationale:In 1891, Dr. Hermann Kümmell, a German surgeon, described a clinical entity characterized by the development of progressive painful kyphosis following an asymptomatic period of months or years after a minor spinal trauma, leading to a gradual collapse of the vertebra and dynamic instability, ultimately progressing to kyphosis with prolonged back pain and/or paraparesis. To date, the main pathologic eliciting event remains unclear, and no standard treatment or single effective treatment are available for Kümmell disease.Patient concerns:A 74-year-old woman presented with severe back pain and numbness of both legs for approximately 2 months.Diagnoses:According to the clinical symptoms and imaging examinations, the patient was diagnosed with stage III Kümmell disease.Interventions:The patient underwent titanium mesh bone grafting combined with pedicle screw internal fixation.Outcomes:Postoperative kyphosis was corrected, and the vertebra was reconstructed.Lessons:Kümmell disease is not a rare complication of osteoporotic vertebral compression fractures, and treatment of each patient must be individualized. The application of titanium mesh bone grafting combined with pedicle screw internal fixation is an effective treatment option for stage III Kümmell disease.

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Modified posterior vertebral column resection for Kümmell disease

Cited by 6 publications

References 8 publications

Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

Treatment of Old Vertebral Compression Fracture With Kyphosis by Different Reconstruction Methods: a Finite Element Analysis

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

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