Liang Chen1, Renbin Dong, Yong Gu, Yu Feng. 1. The First Affiliated Hospital of Soochow University, Department of Orthopaedic Surgery, China; Taizhou Hospital of Zhejiang Province, Department of Orthopaedic Surgery, China.
Abstract
BACKGROUND: Kümmell's disease is a clinical syndrome characterized by a minor spinal trauma with a symptom-free period from months to years, followed by progressive painful kyphosis. Kyphoplasty and vertebroplasty have been introduced to treat Kümmell's disease, and obtained good clinical results. Recently, delayed cement displacement was reported for Kümmell's disease treated by cement augmentation alone. Some authors recommended internal fixation combined with cement injection for this particular condition. OBJECTIVE: To evaluate and compare the clinical efficacy, especially the pain reduction, of 2 procedures (kyphoplasty alone versus short segmental fixation combined with vertebroplasty) in the treatment of Kümmell's disease. STUDY DESIGN: Retrospective evaluation and comparison of postoperative VAS scores and radiographic outcomes. SETTING: Single center inpatient population. METHODS: Two procedures, including conventional balloon kyphoplasty and short segmental fixation combined with vertebroplasty, were utilized for 54 patients with Kümmell's disease. All patients were followed-up for 8-42 months. Visual analog scale (VAS), vertebral height, and local kyphotic angle were evaluated and compared for 2 groups before surgery, after surgery, and at final follow-up. Pearson correlation coefficients were calculated to assess the relationship between the decreased values of pain scores (VAS) and improvement of anterior vertebral height and local kyphotic angle. RESULTS: For the KP group, the VAS pain score decreased significantly from 7.8 ± 0.9 before surgery to 3.3 ± 1.0 after surgery (P < 0.01), and 2.9 ± 0.9 at final follow-up (P < 0.01). The mean height of the anterior vertebral body increased from 14.8 ± 2.4 mm before surgery to 19.3 ± 2.1 mm after surgery (P < 0.01). The mean local kyphotic angle decreased from 22.7 ± 6.9° before surgery to 14.5 ± 5.3° after surgery (P < 0.01). For SSF + VP group, the VAS pain score decreased significantly from 7.2 ± 1.6 before surgery to 4.7 ± 1.3 after surgery (P < 0.01), and 3.5 ± 1.2 at final follow-up (P < 0.01). The mean height of the anterior vertebral body increased from 13.6 ± 2.5mm before surgery to 17.3 ± 2.7 mm after surgery (P < 0.01). The mean local kyphotic angle decreased from 24.7 ± 9.2° before surgery to 15.5 ± 6.2° after surgery (P < 0.01). No significant loss of correction of vertebral height and kyphosis was observed at follow-up. Improvement of VAS score had no correlation with improvement of vertebral height or local kyphotic angle. Asymptomatic cement leakage occurred in both groups. LIMITATIONS: Retrospective study with a relatively small sample size. CONCLUSIONS: This study showed that both balloon kyphoplasty alone and short segmental fixation combined with vertebroplasty for Kümmell's disease were safe and effective. Improvement of VAS score had no correlation with improvement of vertebral height or local kyphotic angle. Comparatively, balloon kyphoplasty resulted in same the clinical outcomes with less complications.
BACKGROUND: Kümmell's disease is a clinical syndrome characterized by a minor spinal trauma with a symptom-free period from months to years, followed by progressive painful kyphosis. Kyphoplasty and vertebroplasty have been introduced to treat Kümmell's disease, and obtained good clinical results. Recently, delayed cement displacement was reported for Kümmell's disease treated by cement augmentation alone. Some authors recommended internal fixation combined with cement injection for this particular condition. OBJECTIVE: To evaluate and compare the clinical efficacy, especially the pain reduction, of 2 procedures (kyphoplasty alone versus short segmental fixation combined with vertebroplasty) in the treatment of Kümmell's disease. STUDY DESIGN: Retrospective evaluation and comparison of postoperative VAS scores and radiographic outcomes. SETTING: Single center inpatient population. METHODS: Two procedures, including conventional balloon kyphoplasty and short segmental fixation combined with vertebroplasty, were utilized for 54 patients with Kümmell's disease. All patients were followed-up for 8-42 months. Visual analog scale (VAS), vertebral height, and local kyphotic angle were evaluated and compared for 2 groups before surgery, after surgery, and at final follow-up. Pearson correlation coefficients were calculated to assess the relationship between the decreased values of pain scores (VAS) and improvement of anterior vertebral height and local kyphotic angle. RESULTS: For the KP group, the VAS pain score decreased significantly from 7.8 ± 0.9 before surgery to 3.3 ± 1.0 after surgery (P < 0.01), and 2.9 ± 0.9 at final follow-up (P < 0.01). The mean height of the anterior vertebral body increased from 14.8 ± 2.4 mm before surgery to 19.3 ± 2.1 mm after surgery (P < 0.01). The mean local kyphotic angle decreased from 22.7 ± 6.9° before surgery to 14.5 ± 5.3° after surgery (P < 0.01). For SSF + VP group, the VAS pain score decreased significantly from 7.2 ± 1.6 before surgery to 4.7 ± 1.3 after surgery (P < 0.01), and 3.5 ± 1.2 at final follow-up (P < 0.01). The mean height of the anterior vertebral body increased from 13.6 ± 2.5mm before surgery to 17.3 ± 2.7 mm after surgery (P < 0.01). The mean local kyphotic angle decreased from 24.7 ± 9.2° before surgery to 15.5 ± 6.2° after surgery (P < 0.01). No significant loss of correction of vertebral height and kyphosis was observed at follow-up. Improvement of VAS score had no correlation with improvement of vertebral height or local kyphotic angle. Asymptomatic cement leakage occurred in both groups. LIMITATIONS: Retrospective study with a relatively small sample size. CONCLUSIONS: This study showed that both balloon kyphoplasty alone and short segmental fixation combined with vertebroplasty for Kümmell's disease were safe and effective. Improvement of VAS score had no correlation with improvement of vertebral height or local kyphotic angle. Comparatively, balloon kyphoplasty resulted in same the clinical outcomes with less complications.