Effectiveness comparison between two operations in treatment of unstable type Kümmell’s disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIANBing ,  HAODingjun , ZHENGYonghong , QIANLixiong , YANGJunsong , LIHoukun , LIHan

Department of Spinal Surgery, Honghui Hospital, Medicine School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

HAODingjun, Email: haodingjun@126.com

Keywords：

Kümmell’s disease; short segmental fixation; vertebroplasty; bone graft

DOI：

10.7507/1002-1892.201608096

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Objective To compare the effectiveness between short segmental fixation combined with vertebroplasty (SSF+VP) and short segmental pedicle screw fixation combined with bone graft (SSF+BG) in the treatment of unstable type Kümmell’s disease so as to provide a reference for the selection of the surgical method. Methods Between March 2013 and February 2015, 48 patients with unstable type Kümmell’s disease who were in accordance with the inclusive criteria were included in the study. SSF+VP were used in 25 cases (SSF+VP group) and SSF+BG in 23 cases (SSF+BG group). There was no significant difference in gender, age, disease duration, bone mineral density, fracture segment, and preoperative visual analogue scale (VAS), Oswestry disability index (ODI), and kyphotic Cobb angle between 2 groups (P>0.05). The operation time and complications related to operation were recorded; the effectiveness was evaluated by VAS, ODI, and kyphotic Cobb angle. Results The operation time was (107.7±18.8) minutes in SSF+VP group and was (113.7±22.4) minutes in SSF+BG group, showing no significant difference between 2 groups (t=–1.045,P=0.302). Bone cement leakage occurred in 6 cases of SSF+VP group, and incision delayed healing occurred in 1 case of SSF+BG group. All patients achieved bone graft fusion on X-ray films. The bone graft fusion time was (15.1±1.3) weeks in SSF+VP group and (15.7±1.8) weeks in SSF+BG group, showing no significant difference between 2 groups (t=–1.361,P=0.180). The VAS, ODI, and kyphotic Cobb angle at immediate after operation and at last follow-up were significantly lower than preoperative ones (P<0.05). The VAS, ODI, and kyphotic Cobb angle had no significant difference between at immediate and at last follow-up in SSF+VP group (P>0.05). In SSF+BG group, VAS at last follow-up was significantly lower than that at immediate after operation (P<0.05), but no significant difference was found in kyphotic Cobb angle and ODI (P>0.05). SSF+VP group was significantly better than SSF+BG group in VAS at immediate after operation (P<0.05), but SSF+BG group was significantly better than SSF+VP group at last follow-up (P<0.05). There was no significant difference in kyphotic Cobb angle and ODI between 2 groups at immediate after operation and at last follow-up (P>0.05). Conclusion SSF+BG can achieve satisfactory effectiveness in the treatment of unstable type Kümmell’s disease, and it has the advantages of good bony healing, obvious improvement of pain, and low complication incidence when compared with SSF+VP.

Citation： QIANBing, HAODingjun, ZHENGYonghong, QIANLixiong, YANGJunsong, LIHoukun, LIHan. Effectiveness comparison between two operations in treatment of unstable type Kümmell’s disease. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 185-190. doi: 10.7507/1002-1892.201608096 Copy

1.	Chen GD, Zhang ZG, Yang HL, et al. Nonunion of osteoporotic vertebral compression fracture with a severe spinal stenosis treated in minimally invasive manner: a case report. Osteoporos Int, 2015, 26(3): 1225-1229.
2.	Ito Y, Hasegawa Y, Toda K, et al. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J, 2002, 2(2): 101-106.
3.	Pappou IP, Papadopoulos EC, Swanson AN, et al. Osteoporotic vertebral fractures and collapse with intravertebral vacuum sige (Kummell’s disease). Orthopedics, 2008, 31(1): 61-66.
4.	Li KC, Li AF, Hsieh CH, et al. Another option to treat Kümmell’s disease with cord compression. Eur Spine J, 2007, 16(9): 1479-1487.
5.	Chen L, Dong R, Gu Y, et al. Comparison between balloon kyphoplasty and short segmental fixation combined with vertebroplasty in the treatment of Kümmell’s disease. Pain Physician, 2015, 18(4): 373-381.
6.	Lee SH, Kim ES, Eoh W. Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell’s disease with cord compression. J Clin Neurosci, 2011, 18(4): 509-514.
7.	Li D, Huang Y, Yang H, et al. Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge. Eur J Orthop Surg Traumatol, 2013, 23(1): 21-26.
8.	Fairbank J, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
9.	赵立来, 童培建, 肖鲁伟, 等. Kümmell病的影像学诊断分析. 中国骨伤, 2016, 29 (5): 460-463.
10.	Hasegawa K, Homma T, Uchiyama S, et al. Vertebral pseudarthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
11.	Jang JS, Kim DY, Lee SH. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body. Spine (Phila Pa 1976), 2003, 28(1): 1588-1592.
12.	Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
13.	Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
14.	Malghem J, Maldague B, Labaisse MA, et al. Intravertebral vacuum cleft: changes in content after supine positioning. Radiology, 1993, 187(2): 483-487.
15.	Zhang GQ, Gao YZ, Zheng J, et al. Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell’s disease with neurological deficits. Exp Ther Med, 2013, 5(2): 517-522.
16.	Li H, Liang CZ, Chen QX. Kümmell’s disease, an uncommon and complicated spinal disorder: a review. J Int Med Res, 2012, 40(2): 406-414.
17.	Wu AM, Chi YL, Ni WF. Vertebral compression fracture with intravertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian Spine J, 2013, 7(2): 148-155.
18.	Yang H, Wang G, Liu J, et al. Balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture nonunion. Orthopedics, 2010, 33(1): 24-28.
19.	Peh WC, Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
20.	Heo DH, Choi JH, Kim MK, et al. Therapeutic efficacy of vertebroplasty in osteoporotic vertebral compression fractures with avascular osteonecrosis. Spine, 2012, 37(7): 423-429.

1. Chen GD, Zhang ZG, Yang HL, et al. Nonunion of osteoporotic vertebral compression fracture with a severe spinal stenosis treated in minimally invasive manner: a case report. Osteoporos Int, 2015, 26(3): 1225-1229.
2. Ito Y, Hasegawa Y, Toda K, et al. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J, 2002, 2(2): 101-106.
3. Pappou IP, Papadopoulos EC, Swanson AN, et al. Osteoporotic vertebral fractures and collapse with intravertebral vacuum sige (Kummell’s disease). Orthopedics, 2008, 31(1): 61-66.
4. Li KC, Li AF, Hsieh CH, et al. Another option to treat Kümmell’s disease with cord compression. Eur Spine J, 2007, 16(9): 1479-1487.
5. Chen L, Dong R, Gu Y, et al. Comparison between balloon kyphoplasty and short segmental fixation combined with vertebroplasty in the treatment of Kümmell’s disease. Pain Physician, 2015, 18(4): 373-381.
6. Lee SH, Kim ES, Eoh W. Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell’s disease with cord compression. J Clin Neurosci, 2011, 18(4): 509-514.
7. Li D, Huang Y, Yang H, et al. Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge. Eur J Orthop Surg Traumatol, 2013, 23(1): 21-26.
8. Fairbank J, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
9. 赵立来, 童培建, 肖鲁伟, 等. Kümmell病的影像学诊断分析. 中国骨伤, 2016, 29 (5): 460-463.
10. Hasegawa K, Homma T, Uchiyama S, et al. Vertebral pseudarthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
11. Jang JS, Kim DY, Lee SH. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body. Spine (Phila Pa 1976), 2003, 28(1): 1588-1592.
12. Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
13. Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
14. Malghem J, Maldague B, Labaisse MA, et al. Intravertebral vacuum cleft: changes in content after supine positioning. Radiology, 1993, 187(2): 483-487.
15. Zhang GQ, Gao YZ, Zheng J, et al. Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell’s disease with neurological deficits. Exp Ther Med, 2013, 5(2): 517-522.
16. Li H, Liang CZ, Chen QX. Kümmell’s disease, an uncommon and complicated spinal disorder: a review. J Int Med Res, 2012, 40(2): 406-414.
17. Wu AM, Chi YL, Ni WF. Vertebral compression fracture with intravertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian Spine J, 2013, 7(2): 148-155.
18. Yang H, Wang G, Liu J, et al. Balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture nonunion. Orthopedics, 2010, 33(1): 24-28.
19. Peh WC, Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
20. Heo DH, Choi JH, Kim MK, et al. Therapeutic efficacy of vertebroplasty in osteoporotic vertebral compression fractures with avascular osteonecrosis. Spine, 2012, 37(7): 423-429.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between two operations in treatment of unstable type Kümmell’s disease

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