Percutaneous Vertebroplasty with Side‐Opening Cannula or Front‐Opening Cannula in the Treatment of Kummell Disease?

Abstract

Objective To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease. Methods A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery. Results A total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05). Conclusion Percutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.

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

“…[1][2][3] The lesions are usually located in the thoracolumbar region and affect a single-level vertebra in the majority of cases. 4,5 KD has rarely been reported in previous studies and can easily be misdiagnosed as a pathological fracture. With advanced imaging technology and additional medical knowledge, more KD cases are being detected, and the prevalence of KD ranges from 7% to 37% among people with osteoporotic vertebral fractures.…”

“…17 , 18 The evidence available has confirmed that PVP is a safe and effective surgical procedure for KD. 1 , 5 , 19 PKP is more conducive to restoring vertebral height and correcting kyphosis and is considered a better choice for patients with significant vertebral height loss (HL) and old fractures with pseudarthrosis. 20 - 22 However, because bone cement is injected into the compressed vertebral body under a large pressure, PKP and PVP may cause associated complications, with bone cement leakage being the most common complication.…”

Impending cauda equina syndrome due to Kummell disease; A case report and literature review

“…More aggressive treatment options comprise of nerve root blockage, vertebral body augmentation, and open surgery [ 6 ]. In neurologically intact patients with painful vertebral fracture, most authors recommend percutaneous vertebral body augmentation with vertebroplasty or kyphoplasty [ [7] , [8] , [9] ]. In these minimally invasive procedures, the unstable vertebra is reconstructed and filed with orthopedic cement and the patient's pain and disability are eliminated immediately after the operation.…”

“…The disease has some characteristic (non-diagnostic) features on imaging that help to differentiate it from post-traumatic kyphosis, infection, osteoporotic fracture, or metastatic involvement [ 4 , 5 ]. Most symptomatic patients show a satisfactory response to conservative or minimally invasive measures such as percutaneous vertebral body cement augmentation, but in those patients with neurological deficit, open surgery may be indicated [ [6] , [7] , [8] , [9] , [10] , [11] ]. Here, we reported a case of a 28 years-old man with KD who presented to us with impending cauda equina syndrome due to L5 involvement which is extremely rare in this disease [ 12 ].…”

Clinical Observations of Kümmell Disease Treatment Through Percutaneous Fixation Combined with Vertebroplasty

“…Due to the cavity and pseudojoint, the vertebral body is unstable, as the disease progresses, patients with Kümmell will gradually develop symptoms such as progressive kyphosis, intractable back pain, or neurological deficits, which seriously affect the quality of life. For Kümmell's disease, non-surgical treatment is usually less effective and carries a risk of pneumonia, bedsores, venous thrombosis of the lower limbs, or delayed neurological deficits 10,11 . At present, surgical treatment of Kümmell's disease is recommended.…”