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

Abstract

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.

Vertebral Body Anterior Translation, a Novel Technique for Delayed Myelopathy Due to Osteoporotic Spine Fractures

“…Besides, we thought reduction of the number of fixation segments would be beneficial for preserving mobile segments, thereby preventing adjacent fractures. In previous studies, surgical modalities were classified as anterior decompression and anterior instrumentation, 11 14) anterior decompression and posterior instrumentation, 9 15 16 17) posterior decompression and instrumentation including posterior shortening osteotomy, 6 18 19 20 21 22) and short-segment posterior spinal fusion with vertebroplasty. 8 23) …”

Intravertebral insertion of Interbody fusion cage via transpedicular approach for the treatment of stage III Kümmell disease：a technical note and case presentation

“…PO and xation can provide relatively secure xation with less complications, and stable xation could help early mobilization with lower incidence of implant-related complications, such as loose screw, screw fracture and screw disconnection (15). However, Osteotomy is a challenging and complicated procedure that requires delicacy and surgeons with more experiences (6). Any error around the spinal cord or medullary cone would be dangerous and might lead to nerve impingement or dural tear (16).…”

“…The current surgical options for management of Kümmell disease are vary, including percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) which are proved to be effective methods for the management of Kümmell's disease without neurological symptoms, and can relieve the pain and restore the height of vertebra to some extent (4). With advanced Kümmell's disease, especially stage III, PVP or PKP are less safe and effective to restore the height of vertebra and provide stability of the spine, therefore titanium mesh bone grafting or osteotomy are the alternative measures for stage III Kümmell's disease (5)(6)(7)(8).…”

An Ultrasensitive Immunoassay Strip for Simultaneously Detectingcyproheptadinehydrochloride and Six Phenothiazinesin Feedstuffs Based on a Monoclonal Antibody

“…In contrast, most surgeons are more familiar with the posterior approach.PO and xation can providerelatively secure xation with less complications,and stable xation could help early mobilization with lower incidence of implant-related complications, such as loosescrew, screw fractureand screw disconnection (15). However, Osteotomy is a challenging and complicated procedure that requires delicacy and surgeons with more experiences (6). Any error around the spinal cord or medullary cone would be dangerous and might lead to nerve impingement or dural tear (16).…”

“…Conservative treatment include bed rest, traction, wearing a brace, analgesics and anti-osteoporosis drugs; However, surgical interventions are recommended if the pain worsen, becomes persistent or new symptoms like radiculopathy, increasing neurological de cit, or signi cant deformity occurs (3). The current surgical options for management of Kümmell disease are vary, including percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) which are proved to be effective methods for the management of Kümmell's disease without neurological symptoms, and can relieve the pain and restore the height of vertebra to some extent (4).With advanced Kümmell's disease, especially stage III, PVP or PKP are less safe and effective to restore the height of vertebra and provide stability of the spine, therefore titanium mesh bone grafting or osteotomy are the alternative measures for stage III Kümmell's disease (5)(6)(7)(8).However, these proceduresare technically demanding and highly risky, and has the characteristics of high blood loss,long duration of surgery and increases the rate of long-term complications, such as loss of correction rate, subsequent vertebral fractures (9). Therefore, less invasive and more safe methods are still needed for the treatment of Kümmell disease, especially the advanced stages.…”