Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell’s disease with neurological deficits

Abstract

The aim of this study was to investigate the treatment of Kümmell’s disease with neurological deficits and to determine whether intravertebral clefts are a pathognomonic sign of Kümmell’s disease. A total of 17 patients who had initially been diagnosed with Kümmell’s disease were admitted, one patient was excluded from this study. Posterior decompression and vertebroplasty for the affected vertebrae were conducted. Pedicle screw fixation and posterolateral bone grafts were performed one level above and one level below the affected vertebrae. Vertebral tissue was extracted for histopathological examination. The mean time of follow-up was 22 months (range, 18 to 42 months). The anterior and middle vertebral heights were measured on standing lateral radiographs prior to surgery, one day postoperatively and at final follow-up. The Cobb angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. The VAS, anterior and middle vertebral heights and the Cobb angle were improved significantly one day postoperatively and at the final follow-up compared with the preoperative examinations (P<0.05). No significant differences were observed between the one-day postoperative results and those at final follow-up (P>0.05). The neurological function of all patients was improved by at least one Frankel grade. All patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. One patient (not included in this study) showed an intravertebral cleft, but the pathology report indicated a non-Hodgkin’s lymphoma. The intravertebral cleft sign is not pathognomonic of Kümmell’s disease. Posterior decompression with short-segment fixation and fusion combined with vertebroplasty is an effective treatment for Kümmell’s disease with neurological deficits.

Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits

“…To the best of our knowledge, no current literature reports compare these two surgical methods. Although both groups achieved similar short-term clinical outcomes, including pain relief, vertebral height recovery, and malformation improvement (P > 0.05), the long-term effects were different; the PFVP group had significant losses of AVH and LKA progression during the 2year follow-up compared to the PVCR group (P < 0.05), which is different from previous studies [20,[33][34][35]. As kyphosis was aggravated over time, patients in the PFVP group complained of more severe back pain than those in the PVCR group (P < 0.05), which is consistent with the VAS results observed in our study.…”

“…However, this method requires relatively high-level surgical skills and a long learning curve [25]. us, for this condition, some scholars have recently recommended PFVP, a relatively simple and minimally invasive approach that does not need to address the anterior lesion [20,26]. Lee et al [26] showed that PFVP is an effective treatment for OVCFs with IVC complicated by neurologic symptoms; however, the authors observed an average 4.5°loss of correction in the kyphotic angle at the final follow-up.…”

“…Owing to the progression of kyphosis with vertebral collapse and intravertebral instability at the cleft site, patients with advanced-stage Kummell's disease are more susceptible to neurological deficits [19]. Minimally invasive procedures, such as percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), have been widely applied once conservative treatment fails for OVCFs with IVC [10,[20][21][22][23]. Although a few studies have confirmed that vertebroplasty could be an alternative intervention for the effective and safe treatment of OVCFs with IVC complicated by neurological deficits, patients with low intravertebral stability and severe spinal cord injuries should be considered candidates for reconstructive surgery [19].…”

“…Although a few studies have confirmed that vertebroplasty could be an alternative intervention for the effective and safe treatment of OVCFs with IVC complicated by neurological deficits, patients with low intravertebral stability and severe spinal cord injuries should be considered candidates for reconstructive surgery [19]. Currently, several open surgery options, mainly consisting of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for IVC complicated by neurological deficits, have been reported in the literature [20,[24][25][26]. However, the preferred surgical option remains controversial.…”

Percutaneous kyphoplasty treatment evaluation for patients with K�mmell disease based on a two‑year follow‑up

“…Traditional surgical interventions may be the first treatment choice for a majority of patients, as conservative treatments, including analgesics and bed rest, exhibit little benefit in pain relief (8). However, shortcomings of open surgery, including major trauma and long recovery times are concerns for patients (9).…”