Clinical application of an improved classification system of Kümmell’s disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yun ¹ , GAO Guan ² , WANG Lei ³ , LI Zhichao ³ , DONG Jianwen ³ ,  XUE Jingcai ³

1. College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250001, P.R.China;
2. Department of Orthopedics, Weihaiwei People’s Hospital, Weihai Shandong, 264200, P.R.China;
3. Department of Orthopedics, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250001, P.R.China;

Corresponding author：

XUE Jingcai, Email: 826067299@qq.com

Keywords：

Kümmell’s disease; modified classification system; treatment; clinical application

DOI：

10.7507/1002-1892.202010042

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Objective To report an improved classification system of Kümmell’s disease and its clinical application.Methods Based on CT and MRI, an improved classification system of Kümmell’s disease was proposed in terms of the integrity of sagittal endplate, the integrity of posterior wall of vertebral body, and the degree of vertebral compression. Between January 2011 and March 2018, the improved classification system was used to evaluate and guide the treatment of 78 patients with Kümmell’s disease. There were 13 males and 65 females. The mean age was 69.1 years (range, 54-85 years). The mean disease duration was 4.0 months (range, 1-8 months). The mean T value of bone mineral density was −3.66 (range, −3.86- −3.34).The fractures located at thoracic vertebrae in 47 cases and lumbar vertebrae in 31 cases. According to the modified classification system of Kümmell’s disease, there were 11 cases of type A1, 13 cases of type A2, 2 cases of type A3, 10 cases of type B1, 18 cases of type B2, 4 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 11 cases of type C3. According to the classification results, the patients of types A and B were treated with percutaneous kyphoplasty (PKP), while the patients of type C were treated with PKP or intra- vertebral fixation according to the degree of vertebral reduction. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate clinical efficacy. The heights of the anterior, middle, and posterior edges of the vertebrae and the Cobb angle were measured to evaluate the reduction of the injured vertebrae and the improvement of kyphosis deformity. The complications were recorded.Results The statistical analysis showed that the improved classification system has good consistency. All patients were followed up 12-36 months (mean, 24.3 months). The heights of anterior, middle, and posterior edges of the vertebrae, Cobb angle, VAS score, and ODI of all types of patients at last follow-up showed significant differences when compared with those before operation (P<0.05). After operation, 4 patients of type A2 had different degree of vertebral height loss; 2 patients of type B2, 3 patients of type C1, and 2 patients of type C2 developed asymptomatic bone cement leakage during PKP; 2 patients of type B3 and 3 patients of type C2 underwent percutaneous internal fixation and vertebral augmentation due to bone cement loosening.Conclusion The modified classification system of Kümmell’s disease can be used to guide treatment of Kümmell’s disease, but the number of clinical application cases is limited, and further application and observation are needed.

Citation： ZHANG Yun, GAO Guan, WANG Lei, LI Zhichao, DONG Jianwen, XUE Jingcai. Clinical application of an improved classification system of Kümmell’s disease. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 464-470. doi: 10.7507/1002-1892.202010042 Copy

1.	赵健博, 侯勇, 司萌. Kummell 病的诊治进展. 创伤外科杂志, 2019, 21(9): 641-644.
2.	Lim J, Choi SW, Youm JY, et al. Posttraumatic delayed vertebral collapse: Kummell’s disease. J Korean Neurosurg Soc, 2018, 61(1): 1-9.
3.	李江笔, 那士博, 公伟权, 等. Kümmell 病的临床治疗进展. 中国骨伤, 2020, 33(1): 81-86.
4.	Zhang J, Fan Y, He X, et al. Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell’s disease? A comparison of two minimally invasive procedures. Int Orthop, 2018, 42(6): 1321-1326.
5.	王庆德, 梅伟, 张振辉, 等. 经椎弓根打压植骨联合后路长节段固定治疗Ⅲ期 Kümmell 病. 中国脊柱脊髓杂志, 2018, 28(6): 522-528.
6.	Steel HH. Kümmell’s disease. Am J Surg, 1951, 81(2): 161-167.
7.	Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Musculoskel Res, 2004, 8(1): 43-55.
8.	Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4): 883-891.
9.	葛朝元, 何立民, 郑永宏, 等. Kümmell 病新分型系统评估及临床应用. 中国脊柱脊髓杂志, 2017, 27(4): 312-319.
10.	Wang W, Liu Q, Liu WJ, et al. Different performance of intravertebral vacuum clefts in Kümmell’s disease and relevant treatment strategies. Orthop Surg, 2020, 12(1): 199-209.
11.	唐永超, 张顺聪, 梁德, 等. 应用过伸位 CT 重建预判椎体强化术治疗Ⅲ期可复型 kümmell’s 病. 广东医学, 2016, 37(14): 2116-2119.
12.	Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
13.	刘键, 李明东, 陈科, 等. 影像学及 PKP 在 Kümmell 病诊疗中运用的相关研究. 中国实验诊断学, 2019, 23(9): 1584-1586.
14.	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.
15.	Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189): 65-76.
16.	薛海鹏, 吴燕, 徐展望, 等. 骨填充囊袋结合体位复位治疗老年 kümmell 病. 中国矫形外科杂志, 2018, 26(3): 271-274.
17.	刘义杰, 杨森, 李雪峰, 等. 经皮椎体后凸成形术治疗无神经症状性Ⅲ期 Kümmell 病. 中华创伤骨科杂志, 2019, 21(10): 888-893.
18.	Yang DL, Yang SD, Chen Q, et al. The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: minimum of one-year follow-up. Med Sci Monit, 2017, 23: 606-612.
19.	陈伯华, 丁文元, 陈其昕, 等. 机器人导航系统联合 3D 打印技术辅助经皮椎体成形术治疗 Kümmell 病的疗效. 中华创伤杂志, 2020, 36(9): 797-803.
20.	路文超, 王宇鹏, 湛川. 椎体后凸成形治疗 Kummell 病过程中发生的骨水泥渗漏. 中国组织工程研究, 2019, 23(2): 172-177.
21.	刘飞俊, 楼超, 金康涛, 等. 经皮后路内固定联合经皮椎体成形术治疗 Kümmell 病继发节段不稳定的短期疗效. 中华创伤杂志, 2020, 36(5): 414-420.
22.	Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebralcollapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
23.	Nakashima H, Imagama S, Yukawa Y, et al. Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976), 2015, 40(2): E120-126.
24.	Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J, 2006, 6(5): 479-487.

1. 赵健博, 侯勇, 司萌. Kummell 病的诊治进展. 创伤外科杂志, 2019, 21(9): 641-644.
2. Lim J, Choi SW, Youm JY, et al. Posttraumatic delayed vertebral collapse: Kummell’s disease. J Korean Neurosurg Soc, 2018, 61(1): 1-9.
3. 李江笔, 那士博, 公伟权, 等. Kümmell 病的临床治疗进展. 中国骨伤, 2020, 33(1): 81-86.
4. Zhang J, Fan Y, He X, et al. Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell’s disease? A comparison of two minimally invasive procedures. Int Orthop, 2018, 42(6): 1321-1326.
5. 王庆德, 梅伟, 张振辉, 等. 经椎弓根打压植骨联合后路长节段固定治疗Ⅲ期 Kümmell 病. 中国脊柱脊髓杂志, 2018, 28(6): 522-528.
6. Steel HH. Kümmell’s disease. Am J Surg, 1951, 81(2): 161-167.
7. Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Musculoskel Res, 2004, 8(1): 43-55.
8. Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4): 883-891.
9. 葛朝元, 何立民, 郑永宏, 等. Kümmell 病新分型系统评估及临床应用. 中国脊柱脊髓杂志, 2017, 27(4): 312-319.
10. Wang W, Liu Q, Liu WJ, et al. Different performance of intravertebral vacuum clefts in Kümmell’s disease and relevant treatment strategies. Orthop Surg, 2020, 12(1): 199-209.
11. 唐永超, 张顺聪, 梁德, 等. 应用过伸位 CT 重建预判椎体强化术治疗Ⅲ期可复型 kümmell’s 病. 广东医学, 2016, 37(14): 2116-2119.
12. Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
13. 刘键, 李明东, 陈科, 等. 影像学及 PKP 在 Kümmell 病诊疗中运用的相关研究. 中国实验诊断学, 2019, 23(9): 1584-1586.
14. 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.
15. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189): 65-76.
16. 薛海鹏, 吴燕, 徐展望, 等. 骨填充囊袋结合体位复位治疗老年 kümmell 病. 中国矫形外科杂志, 2018, 26(3): 271-274.
17. 刘义杰, 杨森, 李雪峰, 等. 经皮椎体后凸成形术治疗无神经症状性Ⅲ期 Kümmell 病. 中华创伤骨科杂志, 2019, 21(10): 888-893.
18. Yang DL, Yang SD, Chen Q, et al. The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: minimum of one-year follow-up. Med Sci Monit, 2017, 23: 606-612.
19. 陈伯华, 丁文元, 陈其昕, 等. 机器人导航系统联合 3D 打印技术辅助经皮椎体成形术治疗 Kümmell 病的疗效. 中华创伤杂志, 2020, 36(9): 797-803.
20. 路文超, 王宇鹏, 湛川. 椎体后凸成形治疗 Kummell 病过程中发生的骨水泥渗漏. 中国组织工程研究, 2019, 23(2): 172-177.
21. 刘飞俊, 楼超, 金康涛, 等. 经皮后路内固定联合经皮椎体成形术治疗 Kümmell 病继发节段不稳定的短期疗效. 中华创伤杂志, 2020, 36(5): 414-420.
22. Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebralcollapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
23. Nakashima H, Imagama S, Yukawa Y, et al. Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976), 2015, 40(2): E120-126.
24. Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J, 2006, 6(5): 479-487.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of an improved classification system of Kümmell’s disease

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