Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage <b>Ⅲ</b> Kümmell disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Yuliang ,  XIONG Xiaoming , WAN Dun , DENG Xuangeng , SHI Huagang , SONG Simao , GU Tao , HOU Wei

Department of Spine Surgery, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XIONG Xiaoming, Email: 2841710476@qq.com

Keywords：

Kümmell disease; short-segment fixation; long-segment fixation; osteoporosis; vertebroplasty

DOI：

10.7507/1002-1892.202004053

Video：

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Objective To compare the effectiveness of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease.Methods A clinical data of 44 patients with stage Ⅲ Kümmell disease met the selection criteria between January 2014 and December 2017 was retrospectively analyzed. Eighteen cases were treated with short-segment bone cement-augmented fixation combined with vertebroplasty (short-segment group) and 26 cases were treated with long-segment bone cement-augmented fixation combined with vertebroplasty (long-segment group). There was no significant difference in gender, age, disease duration, fracture segment, bone mineral density (T value), Frankle grading, and preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior edge height of injured vertebrae, kyphosis Cobb angle, and thoracolumbar kyphosis (TLK) between the two groups (P>0.05). The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK were compared between the two groups.Results The operation time and the intraoperative blood loss in the short- segment group were significant lower than those in the long-segment group (P<0.05). There was no significant difference in bone cement injection volume and bone cement leakage rate between the two groups (P>0.05). All patients were followed up 12-36 months, with an average of 24.4 months. The VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK significantly improved at 1 week after operation and last follow-up in the two groups (P<0.05), there was no significant difference between the two groups (P>0.05). At last follow-up, the neurological function of the two groups recovered, and there was no significant difference in Frankle grading between the two groups (P>0.05). There were 3 cases (16.67%) of non-surgical vertebral fractures in the short-segment group and 6 cases (23.08%) in the long-segment group, showing no significant difference between the two groups (P>0.05). Bone rejection occurred in 1 case in the short-segment group, and neither internal fixation failure nor collapse of the injured vertebrae occurred during follow-up.Conclusion Both short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty can achieve good effectiveness in treatment of stage Ⅲ Kümmell disease, and can maintain the height of the injured vertebra and prevent the collapse of the injured vertebra. Compared with long-segment fixation, short-segment fixation has the advantages of shorter operation time and less intraoperative bleeding.

Citation： SUN Yuliang, XIONG Xiaoming, WAN Dun, DENG Xuangeng, SHI Huagang, SONG Simao, GU Tao, HOU Wei. Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1275-1280. doi: 10.7507/1002-1892.202004053 Copy

1.	Zhang X, Hu W, Yu J, et al. An effective treatment option for kümmell disease with neurological deficits: modified transpedicular subtraction and disc osteotomy combined with long-segment fixation. Spine (Phila Pa 1976), 2016, 41(15): E923-930.
2.	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. Clin Neurosci, 2011, 18(4): 509-514.
3.	Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
4.	Huang YS, Hao DJ, Wang XD, et al. Long-segment or bone cement-augmented short-segment fixation for Kummell disease with neurologic deficits? A comparative cohort study. World Neurosurgery, 2018, 116: e1079-e1086.
5.	Huang YS, Ge CY, Feng H, et al. Bone cement-augmented short-segment pedicle screw fixation for Kümmell disease with spinal canal stenosis. Med Sci Monit, 2018, 24: 928-935.
6.	李业成, 张巍, 张成亮, 等. 骨水泥强化椎弓根螺钉固定结合椎体后凸成形术治疗Ⅲ型 Kummell 病. 实用骨科杂志, 2017, 23(6): 496-499.
7.	Di HX, Liu FY, Yang SD, et al. Short-segment fixation with a cement-augmented pedicle screw for Kummell disease: Case report. Medicine (Baltimore), 2017, 96(50): e8617.
8.	陈浩, 杨俊松, 郝定均. 后路短节段固定骨水泥增强治疗Ⅲ期 Kümmell 病伴椎管狭窄. 中国修复重建外科杂志, 2019, 33(6): 707-711.
9.	罗川桂, 秦登明, 吴巍. 短节段固定骨水泥强化联合伤椎椎体成形治疗Ⅲ期 Kümmell 病. 颈腰痛杂志, 2020, 41(3): 314-317.
10.	刘宁, 丁美兰, 伍耀宏, 等. 后路减压结合骨水泥强化椎弓根螺钉固定治疗合并神经损伤Ⅲ型 Kümmell 病. 江西医药, 2019, 54(5): 479-482.
11.	邓轩赓, 熊小明, 万趸, 等. 单节段胸腰椎Ⅲ期 Kümmell 病短节段和长节段强化固定的临床比较研究. 中国骨伤, 2019, 32(7): 598-603.
12.	陈峰, 方文来, 倪文飞. Kummell 病的治疗进展. 中国骨与关节损伤杂志, 2013, 28(1): 95-96.
13.	Katsumi K, Hirano T, Watanabe K, et al. Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective muhicenter study. Int Orthop, 2016, 40(11): 2309-2315.
14.	Cheh G, Bridwell KH, Lenke LG, et al. Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation: a-minimum 5-year follow-up. Spine (Phila Pa 1976), 2007, 32(20): 2253-2257.
15.	Hoppe S, Wangler S, Aghayev E, et al. Reduction of cement leakage by sequential PMMA application in a vertebroplasty model. Eur Spine J, 2016, 25(11): 3450-3455.
16.	张云庆, 杨惠光, 刘勇, 等. 球囊扩张椎体后凸成形术结合过伸体位复位治疗中晚期 Kümmell 病的疗效分析. 中国修复重建外科杂志, 2012, 26(4): 411-415.

1. Zhang X, Hu W, Yu J, et al. An effective treatment option for kümmell disease with neurological deficits: modified transpedicular subtraction and disc osteotomy combined with long-segment fixation. Spine (Phila Pa 1976), 2016, 41(15): E923-930.
2. 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. Clin Neurosci, 2011, 18(4): 509-514.
3. Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
4. Huang YS, Hao DJ, Wang XD, et al. Long-segment or bone cement-augmented short-segment fixation for Kummell disease with neurologic deficits? A comparative cohort study. World Neurosurgery, 2018, 116: e1079-e1086.
5. Huang YS, Ge CY, Feng H, et al. Bone cement-augmented short-segment pedicle screw fixation for Kümmell disease with spinal canal stenosis. Med Sci Monit, 2018, 24: 928-935.
6. 李业成, 张巍, 张成亮, 等. 骨水泥强化椎弓根螺钉固定结合椎体后凸成形术治疗Ⅲ型 Kummell 病. 实用骨科杂志, 2017, 23(6): 496-499.
7. Di HX, Liu FY, Yang SD, et al. Short-segment fixation with a cement-augmented pedicle screw for Kummell disease: Case report. Medicine (Baltimore), 2017, 96(50): e8617.
8. 陈浩, 杨俊松, 郝定均. 后路短节段固定骨水泥增强治疗Ⅲ期 Kümmell 病伴椎管狭窄. 中国修复重建外科杂志, 2019, 33(6): 707-711.
9. 罗川桂, 秦登明, 吴巍. 短节段固定骨水泥强化联合伤椎椎体成形治疗Ⅲ期 Kümmell 病. 颈腰痛杂志, 2020, 41(3): 314-317.
10. 刘宁, 丁美兰, 伍耀宏, 等. 后路减压结合骨水泥强化椎弓根螺钉固定治疗合并神经损伤Ⅲ型 Kümmell 病. 江西医药, 2019, 54(5): 479-482.
11. 邓轩赓, 熊小明, 万趸, 等. 单节段胸腰椎Ⅲ期 Kümmell 病短节段和长节段强化固定的临床比较研究. 中国骨伤, 2019, 32(7): 598-603.
12. 陈峰, 方文来, 倪文飞. Kummell 病的治疗进展. 中国骨与关节损伤杂志, 2013, 28(1): 95-96.
13. Katsumi K, Hirano T, Watanabe K, et al. Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective muhicenter study. Int Orthop, 2016, 40(11): 2309-2315.
14. Cheh G, Bridwell KH, Lenke LG, et al. Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation: a-minimum 5-year follow-up. Spine (Phila Pa 1976), 2007, 32(20): 2253-2257.
15. Hoppe S, Wangler S, Aghayev E, et al. Reduction of cement leakage by sequential PMMA application in a vertebroplasty model. Eur Spine J, 2016, 25(11): 3450-3455.
16. 张云庆, 杨惠光, 刘勇, 等. 球囊扩张椎体后凸成形术结合过伸体位复位治疗中晚期 Kümmell 病的疗效分析. 中国修复重建外科杂志, 2012, 26(4): 411-415.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease

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