PERCUTANEOUS KYPHOPLASTY IN HYPEREXTENSION POSITION FOR TREATMENT OF MIDDLE ANDLATE PERIOD Kümmell DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yunqing ¹ , YANG Huiguang ¹ , LIU Yong ¹ , ZHOU Feng ¹ , DENG Xiongwei ¹ , LUO Wenxing ¹ , CHEN Liang. ²

1Department of Orthopedic Surgery, Jiangyin Hospital, Southeast University, Jiangyin Jiangsu, 214400,P.R.China;;
2Department of Orthopedics, the First Affiliated Hospital of Soochow University.;

Corresponding author：

Keywords：

Kümmell disease; Kyphoplasty; Hyperextension position

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Objective To evaluate the feasibil ity and effectiveness of percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease. Methods Between May 2003 and February 2009, 17 patients with Kümmell disease (6 at stage II, 11 at stage III) were treated with percutaneous kyphoplasty in hyperextension position. There were 5 males and 12 females with an average age of 71 years (range, 55-85 years). The involved vertebral bodies were T10 in 1 case, T11 in 3 cases, T12 in 7 cases, L1 in 4 cases, L2 in 1 case, and T12, L1 in 1 case by X-ray, CT, and MRI examinations. The effectiveness was determined by the visual analogue scale (VAS) and the Oswestry Disabil ity Index (ODI). The height and the kyphotic Cobb angle of the involved vertebral body were measured pre- and postoperatively. Results The operation was successfully completed in all the patients, and the incisions healed by first intention. Pain was alleviated or eliminated within 48 hours after operation; no spinal nerves injury or pulmonary embolism occurred. One patient had cement leakage to the adjacent disc, who did not manifest any cl inical symptoms. Thirteen patients were followed up 24 to 56 months (mean, 32 months). The VAS score, ODI, anterior and medial vertebral height, kyphotic Cobb angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P lt; 0.05), there was no significant difference between at 1 week after operation and at last follow-up (P gt; 0.05). Adjacent vertebral fracture occurred in 1 patient at 6 months after operation and was cured after percutaneous kyphoplasty. Conclusion Percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease can rel ieve back pain, improve viabil ity, decrease Cobb angle, and retain the vertebral body height and spinal alignment. The general condition of the patient is needed to be evaluated and the operation indication should be controlled strictly.

Citation： ZHANG Yunqing,YANG Huiguang,LIU Yong,ZHOU Feng,DENG Xiongwei,LUO Wenxing,CHEN Liang.. PERCUTANEOUS KYPHOPLASTY IN HYPEREXTENSION POSITION FOR TREATMENT OF MIDDLE ANDLATE PERIOD Kümmell DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 411-415. doi: Copy

1.	Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Muscul Res, 2004, 8(2): 43-55.
2.	. Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
3.	van der Schaaf I, Fransen H. Percutaneous vertebroplasty as treatment for Kümmell’s disease. JBR-BTR, 2009, 92(2): 83-85.
4.	Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
5.	刘勇, 陈亮, 顾勇, 等. 椎体后凸成形术结合过伸体位复位治疗骨质疏松性椎体压缩骨折伴椎体真空征. 中国修复重建外科杂志, 2011, 25(1): 79-83.
6.	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): 24-31.
7.	Pappou IP, Papadopoulos EC, Swanson AN, et al. Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign (Kümmel’s disease). Orthopedics, 2008, 31(1): 61-66.
8.	Sirvanci M, Duran C, Aydiner O. Intravertebral vacuum phenomenon that developed during transpedicular biopsy. Clin Radiol, 2002, 57(8): 761-764.
9.	Sarli M, Pérez Manghi FC, Gallo R, et al. The vacuum cleft sign: an uncommon radiological sign. Osteoporos Int, 2005, 16(10): 1210-1214.
10.	Grohs JG, Matzner M, Trieb K, et al. Treatment of intravertebral pseudarthroses by balloon kyphoplasty. J Spinal Disord Tech, 2006, 19(8): 560-565.
11.	Saito F, Takahashi K, Tanaka S, et al. Effects of vertebroplasty for delayed-onset paraplegia caused by vertebral pseudarthrosis. J Orthop Sci, 2011, 16(6): 673-681.
12.	Hashidate H, Kamimura M, Nakagawa H, et al. Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history. J Orthop Sci, 2006, 11(1): 28-33.
13.	Jung JY, Lee MH, Ahn JM. Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft. J Comput Assist Tomogr, 2006, 30(3): 501-506.
14.	Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J, 2011, 11(9): 839-848.
15.	杨惠林, 牛国旗, 王根林, 等. 椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折. 中华骨科杂志, 2006, 26(3): 165-169.
16.	Liu JT, Liao WJ, Tan WC, et al. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int, 2010, 21(2): 359-364.
17.	Boonen S, Wahl DA, Nauroy L, et al. Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporos Int, 2011, 22(12): 2915-2934.
18.	Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture cleft in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
19.	陈亮, 杨惠林, 唐天驷. 椎体后凸成形术骨水泥椎间隙内渗漏的随访分析. 中华骨科杂志, 2008, 28(12): 1015-1018.
20.	Kim YJ, Lee JW, Park KW, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology, 2009, 251(1): 250-259.

1. Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Muscul Res, 2004, 8(2): 43-55.
2. . Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
3. van der Schaaf I, Fransen H. Percutaneous vertebroplasty as treatment for Kümmell’s disease. JBR-BTR, 2009, 92(2): 83-85.
4. Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
5. 刘勇, 陈亮, 顾勇, 等. 椎体后凸成形术结合过伸体位复位治疗骨质疏松性椎体压缩骨折伴椎体真空征. 中国修复重建外科杂志, 2011, 25(1): 79-83.
6. 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): 24-31.
7. Pappou IP, Papadopoulos EC, Swanson AN, et al. Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign (Kümmel’s disease). Orthopedics, 2008, 31(1): 61-66.
8. Sirvanci M, Duran C, Aydiner O. Intravertebral vacuum phenomenon that developed during transpedicular biopsy. Clin Radiol, 2002, 57(8): 761-764.
9. Sarli M, Pérez Manghi FC, Gallo R, et al. The vacuum cleft sign: an uncommon radiological sign. Osteoporos Int, 2005, 16(10): 1210-1214.
10. Grohs JG, Matzner M, Trieb K, et al. Treatment of intravertebral pseudarthroses by balloon kyphoplasty. J Spinal Disord Tech, 2006, 19(8): 560-565.
11. Saito F, Takahashi K, Tanaka S, et al. Effects of vertebroplasty for delayed-onset paraplegia caused by vertebral pseudarthrosis. J Orthop Sci, 2011, 16(6): 673-681.
12. Hashidate H, Kamimura M, Nakagawa H, et al. Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history. J Orthop Sci, 2006, 11(1): 28-33.
13. Jung JY, Lee MH, Ahn JM. Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft. J Comput Assist Tomogr, 2006, 30(3): 501-506.
14. Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J, 2011, 11(9): 839-848.
15. 杨惠林, 牛国旗, 王根林, 等. 椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折. 中华骨科杂志, 2006, 26(3): 165-169.
16. Liu JT, Liao WJ, Tan WC, et al. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int, 2010, 21(2): 359-364.
17. Boonen S, Wahl DA, Nauroy L, et al. Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporos Int, 2011, 22(12): 2915-2934.
18. Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture cleft in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
19. 陈亮, 杨惠林, 唐天驷. 椎体后凸成形术骨水泥椎间隙内渗漏的随访分析. 中华骨科杂志, 2008, 28(12): 1015-1018.
20. Kim YJ, Lee JW, Park KW, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology, 2009, 251(1): 250-259.

Chinese Journal of Reparative and Reconstructive Surgery

PERCUTANEOUS KYPHOPLASTY IN HYPEREXTENSION POSITION FOR TREATMENT OF MIDDLE ANDLATE PERIOD Kümmell DISEASE

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