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

Abstract

Objective

To explore the safety and efficacy of percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of stage III Kümmell disease.

Methods

The clinical data and follow‐up results of 22 patients with Kümmell disease who were admitted to our department from 2014 to 2018 were analyzed. There were 14 females and eight males, and the Age range was 58–81 years. All patients were followed up for 24 months. The treatment method was percutaneous pedicle screw fixation combined with vertebroplasty. The patient general information such as age, gender, bedrest time and location of fracture vertebrae were recorded. The clinical symptoms and imaging data of visual analogue scale (VAS), bone cement leakage, Oswestry Disability Index (ODI), Cobb angle, anterior, middle and posterior height of the diseased vertebral body, and complications were recorded before operation and during follow‐up.

Results

For patients enrolled, no bone cement leakage was observed during the operation; no patients developed infections after operation. The operation was safe and resulted in a short bedrest time. The VAS score and ODI index at 3 and 24 months postoperative (2.86 ± 0.83, 31.68% ± 6.21%; 3.0 ± 0.82, 32.78% ± 6.05%) were significantly lower than that recoded preoperatively (7.59 ± 0.59, 71.5% ± 8.84%) ( P < 0.05). Additionally, there was no significant difference between the records at 3 and 24 months after operation ( P > 0.05). Imaging data showed that the bone cement and screws were in good position and did not move during postoperative and follow‐up. The anterior, middle and posterior height of the diseased vertebral body measured 2 days after surgery (23.46 ± 4.72, 23.12 ± 3.05, 25.81 ± 2.22) and at last follow‐up (20.83 ± 4.48, 21.78 ± 2.74, 24.74 ± 1.93) were higher than that recorded preoperatively (13.08 ± 4.49, 12.93 ± 3.53, 19.32 ± 2.73) ( P < 0.05), and the Cobb angle measured 2 days and 24 months after operation (9.57 ± 4.63, 10.68 ± 3.97) were lower than that recorded preoperatively (28.24 ± 8.95) ( P < 0.05), and no significant difference was found between the values recorded at 2 days and 24 months after operation ( P > 0.05). Follow‐up for 24 months, there was no re‐fracture of the diseased vertebrae and internal fixation loosening, but two cases of adjacent vertebral refracture complications occurred, and the effect was good after PVP treatment.

Conclusion

Short‐segment percutaneous pedicle screw fixation combined with vertebroplasty in the treatment of stage III Kümmel disease can effectively restore the height of the diseased vertebrae, kyphosis correction, reduce trauma, prevent the diseased vertebral body from collapsing again, and effectively improves clinical symptoms.

Abstract

Schematic diagram of percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of stage III Kümmell disease. (A, D) Stage III Kümmell disease: vertebral compression, Cobb angle enlargement, posterior vertebral cortical rupture with spinal cord compression. (B, E) Percutaneous pedicle screw fixation: decrease the Cobb angle, enlarge the upper and lower gap of the diseased vertebrae and restore the height of the diseased vertebrae. (C, F) Percutaneous vertebroplasty: injection of bone cement to fill the enlarged diseased vertebral cavity to restore the height and stability of the vertebral body.