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      Balloon Kyphoplasty: An Effective Treatment for Kummell Disease?

      research-article
      ,
      Korean Journal of Spine
      The Korean Spinal Neurosurgery Society
      Osteonecrosis, Osteoporosis, Kyphoplasty

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          Abstract

          Objective

          The purpose of this study was to evaluate the efficacy of balloon kyphoplasty for treating Kummel disease accompanying severe osteoporosis.

          Methods

          Twelve patients with single-level Kummell disease accompanied by severe osteoporosis were enrolled in this investigation. After postural reduction for 1 or 2 days, balloon kyphoplasty was performed on the collapsed vertebrae. Clinical results, radiological parameters, and related complications were assessed at 7 days, 1 month and 6 months after the procedure.

          Results

          Prior to kyphoplasty, the mean pain score (according to the visual analogue scale) was 8.0. Seven days after the procedure, this score improved to 2.5. Despite the significant improvement compared to preoperative value, the score increased to 4.0 at 6 months after the procedure. The mean preoperative vertebral height loss was 55.4%. Kyphoplasty reduced this loss to 31.6%, but it increased to 38.7% at 6 months after the procedure. The kyphotic angle improved significantly from 22.4°±4.9° (before the procedure) to 10.1°±3.8° after surgery, However, the improved angle was not maintained 6 months after the procedure. The mean correction loss for the kyphotic deformity was 7.2° at 6 months after the procedure. Three out of 12 patients sustained adjacent fractures after balloon kyphoplasty within 6 months.

          Conclusion

          Although balloon kyphoplasty for treating Kummell disease is known to provide stabilization and pain relief, it may be associated with the development of adjacent fractures and aggravated kyphosis.

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          Most cited references12

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          Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty.

          This study was undertaken to investigate the incidence rate, characteristics, and predisposing factors associated with recollapse of the same vertebrae after percutaneous vertebroplasty (PVP). Recollapse of the same vertebra after PVP is the one of the complications of the procedure, and the incidence rate in our study was 3.21%. The most important predisposing factor was pre-operative osteonecrosis. Recollapse was not related to trauma. PVP using polymethylmethacrylate has become a popular treatment for osteoporotic vertebral compression fracture. Recollapse of the same vertebrae after PVP has rarely been reported. This study was undertaken to investigate the incidence, characteristics, and predisposing factors associated with recollapse of the same vertebrae after PVP. Eleven patients (seven females and four males; mean age, 69.91 +/- 5.49 years), out of a total of 343 patients, developed recollapse of the same vertebra after PVP. The 11 patients who developed recollapse comprised the "recollapse group", while the remaining 332 patients comprised the "well-maintained group". Pre-operative magnetic resonance imaging revealed that the incidence of osteonecrosis was significantly higher in the recollapse group than the well-maintained group (p < 0.05). The degree of re-expansion of the compressed vertebral body after PVP was significantly higher in the recollapse group than in the well-maintained group (p < 0.05). The most important predisposing factor for recollapse was pre-operative osteonecrosis. Recollapse was not related to trauma. Osteoporotic vertebral compression fracture with osteonecrosis or pseudoarthrosis has been regarded as a relative indication for PVP; however, the findings of this study suggest that this disease category may be a relative contraindication for PVP.
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            Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts.

            We present the clinical and radiological results of percutaneous vertebroplasty in the treatment of 58 vertebral compression fractures in 51 patients at a minimum follow-up of two years. Group 1 consisted of 39 patients, in whom there was no associated intravertebral cleft, whilst group 2 comprised 12 patients with an intravertebral cleft. The Oswestry disability index (ODI) and visual analogue scale (VAS) scores were recorded prospectively. The radiological evidence of kyphotic deformity, vertebral height, leakage of cement and bone resorption around the cement were studied retrospectively, both before and after operation and at the final follow-up. The ODI and VAS scores in both groups decreased after treatment, but the mean score in group 2 was higher than that in group 1 (p = 0.02 (ODI), p = 0.02 (VAS)). There was a greater initial correction of the kyphosis in group 2 than in group 1, although the difference was not statistically significant. However, loss of correction was greater in group 2. Leakage of cement was seen in 24 (41.4%) of 58 vertebrae (group 1, 32.6% (15 of 46); group 2, 75% (9 of 12)), mainly of type B through the basal vertebral vein in group 1 and of type C through the cortical defect in group 2. Resorption of bone around the cement was seen in three vertebrae in group 2 and in one in group 1. There were seven adjacent vertebral fractures in group 1 and one in group 2. Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures with or without an intravertebral cleft. Nonetheless, higher rates of complications related to the cement must be recognised in patients in the presence of an intravertebral cleft.
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              Delayed post-traumatic osteonecrosis of a vertebral body (Kummell's disease).

              Kummell's disease is a rare spinal disorder characterized as avascular necrosis of a vertebral body occurring in a delayed fashion after minor trauma. The disease derives its name from the German surgeon Hermann Kummell, who described a series of patients with the disorder in 1895. Kummell's disease is distinguished from typical osteoporotic compression fractures, by virtue of the fact that patients with Kummell's disease develop symptoms in delayed fashion. In addition, Kummell's disease exhibits different signal characteristics on magnetic resonance imaging when compared to osteoporotic compression fractures. In this review we discuss the pathophysiology, histopathology and treatment of this interesting disorder.
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                Author and article information

                Journal
                Korean J Spine
                Korean J Spine
                KJS
                Korean Journal of Spine
                The Korean Spinal Neurosurgery Society
                1738-2262
                2093-6729
                September 2016
                30 September 2016
                : 13
                : 3
                : 102-106
                Affiliations
                Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea.
                Author notes
                Corresponding Author: Seok Won Kim. Department of Neurosurgery, Chosun University College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: +82-62-220-3126, Fax: +82-62-227-4575, ns64902@ 123456hanmail.net
                Article
                10.14245/kjs.2016.13.3.102
                5086459
                27799987
                e9496fc3-8775-4608-bf6f-bbac61a009e1
                Copyright © 2016 The Korean Spinal Neurosurgery Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 April 2016
                : 07 June 2016
                : 14 June 2016
                Categories
                Clinical Article

                osteonecrosis,osteoporosis,kyphoplasty
                osteonecrosis, osteoporosis, kyphoplasty

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