Prevention of Bone Cement Displacement in Kümmell Disease without Neurological Deficits through Treatment with a Novel Hollow Pedicle Screw Combined with Kyphoplasty

Abstract

Objective

Displacement of bone cement following percutaneous vertebral augmentation for Kümmell disease (KD) presents a significant concern, resulting in increasing back pain and compromising daily activities. Unfortunately, current literature does not yet establish a validated and minimally invasive surgical intervention for this issue. This study aims to investigate the effects of a novel hollow pedicle screw combined with kyphoplasty (HPS‐KP) in preventing bone cement displacement following simply percutaneous kyphoplasty for the management of KD.

Methods

A total of 22 patients (six males, 16 females, averagely aged 77.18 ± 7.63 years) with KD without neurological deficits treated by HPS‐KP at the hospital between March 2021 and June 2022 were hereby selected, among which, there were three stage I KD cases, 12 stage II KD cases, and seven stage III KD cases according to Li's classification. Bone mineral density (BMD), spinal X‐ray, computed tomography (CT), and magnetic resonance imaging (MRI) were examined before the operation. The operation time, intraoperative blood loss, and postoperative complications were all recorded. The follow‐up focused on visual analog scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), wedge‐shape affected vertebral Cobb angle (WCA), and bisegmental Cobb angle (BCA). One‐way analysis of variance (ANOVA) followed by Bonferroni post‐hoc test was employed for performing multiple comparisons in the present study.

Results

All patients having received the operation successfully were followed up for more than 8 months (ranging from 8 to 18 months). The operation time, intraoperative blood loss, and BMD (T‐score) were 39.09 ± 5.64 min, 14.09 ± 3.98 ml, and − 3.30 ± 0.90 g/cm ³, respectively. Statistically significant differences were observed in the VAS score, ODI, AVH, MVH, and WCA (All p < 0.05), but there was no statistically significant difference in PVH and BCA at different time points (All p > 0.05). During follow‐up, five patients suffered from bone cement leakage, and one presented an adjacent vertebral fracture and no bone cement displacement.

Conclusion

HPS‐KP could be safe and effective in the treatment of KD without neurological deficits, effectively relieving the symptoms of patients, restoring partial vertebral height, and preventing the occurrence of bone cement displacement.

Abstract

Bone cement displacement was a chronic complication after vertebral augmentation in the treatment of Kümmell disease (KD). At present, the minimally invasive surgeries for the treatment of KD to prevent bone cement displacement are still incomplete. A novel hollow pedicle screw device was designed to combine with kyphoplasty for minimally invasive surgical treatment of KD, which could effectively prevent the occurrence of bone cement displacement.