Comparison between Balloon Kyphoplasty
and Short Segmental Fixation Combined with
Vertebroplasty in the Treatment of Kümmell’s
Disease

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. Key words: Kümmell’s disease, kyphoplasty, vertebroplasty, short segmental fixation, pain

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Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease

10.21203/rs.3.rs-122096/v1 ◽

2020 ◽

Author(s):

Dan Pan ◽

Xiaojie Ouyang ◽

Qinghua Huang ◽

Dayong Chen

Keyword(s):

Bone Cement ◽

Operative Time ◽

Cement Leakage ◽

Vertebral Height ◽

Kyphotic Angle ◽

Injection Volume ◽

Kummell’S Disease ◽

Kümmell’S Disease ◽

Better Than

Abstract Background: Percutaneous kyphoplasty (PKP) is effective for the treatment of Kummell's disease. However, controversy remains regarding whether a unipedicular or bipedicular PKP is superior.Methods: A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21) . Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated.Results: All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < 0.05) , and local kyphotic angle and average vertebral height were restored markedly (P < 0.05). Operative time of both groups had no significant difference (P > 0.05). Bone cement injection volume was larger in bipedicular group (P < 0.05). At 1 day after operation and the last follow-up , the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < 0.05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > 0.05).Conclusion: Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.

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Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits-A Retrospective Case Series

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211027055 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110270

Author(s):

Hyung-Youl Park ◽

Ki-Won Kim ◽

Ji-Hyun Ryu ◽

S. Tim Yoon ◽

In-Hwa Baek ◽

...

Keyword(s):

Surgical Technique ◽

Posterior Fusion ◽

Kyphotic Angle ◽

Neurologic Deficits ◽

Surgical Methods ◽

Kummell’S Disease ◽

The Mean ◽

Frankel Grade ◽

Kümmell’S Disease

Purpose: Various surgical methods have been reported for Kummell’s disease with neurologic deficits. The aim of this study was to introduce long-segmental posterior fusion (LPF) combined with vertebroplasty (VP) and wiring as an alternative surgical technique. Material and Methods: We retrospectively analyzed 10 patients undergoing posterior decompression and LPF combined with VP and wiring for Kummell’s disease with neurologic deficits from January 2011 to December 2014. The radiologic outcomes included the local kyphotic angle (LKA) and segmental kyphotic angle (SKA). Clinical outcomes, including the visual analog scale (VAS), the Oswestry Disability Index (ODI) and the Frankel grade were assessed. Surgery-related complications were also evaluated. Results: The mean age of the included patients was 77 ± 8 years with a mean follow-up period of 31.4 ± 4.9 months and a mean bone mineral density of −3.5 ± 0.7 (T-score). The mean operation time was 220 ± 32.3 minutes with a mean blood loss of 555 ± 125.7 mL. The preoperative LKA and SKA were significantly corrected postoperatively (37.9 ± 8.7° vs. 15.3 ± 5.3°, p = 0.005 for LKA; 21.3 ± 5.1° vs. 7.6 ± 2.8°, p = 0.005 for SKA) without a loss of correction at the last follow-up. The VAS and ODI were also significantly improved (7.7 ± 1.1 vs. 3.0 ± 1.6, p = 0.007 for VAS; 90.3 ± 8.9 vs. 49.6 ± 22.7, p = 0.007 for ODI). The Frankel grade of all patients was improved by at least 1 or 2 grades at the last follow-up. Surgery-related complications such as intraoperative cement leakage and implant loosening during the follow-up were not observed. Conclusions: LPF combined with VP and wiring might be an effective surgical option for Kummell’s disease with neurologic deficits, especially for the elderly patients with morbidities. Level of Evidence: level IV.

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Balloon kyphoplasty in the treatment of metastatic tumors of the upper thoracic spine

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine09909 ◽

2011 ◽

Vol 14 (3) ◽

pp. 372-376 ◽

Cited By ~ 16

Author(s):

Mohammed Eleraky ◽

Ioannis Papanastassiou ◽

Matthias Setzer ◽

Ali A. Baaj ◽

Nam D. Tran ◽

...

Keyword(s):

Pain Relief ◽

Thoracic Spine ◽

Balloon Kyphoplasty ◽

Metastatic Tumors ◽

Kyphotic Angle ◽

Upper Thoracic Spine ◽

Vertebral Bodies ◽

The Mean ◽

Upper Thoracic

Object Balloon kyphoplasty has recently been shown to be effective in providing rapid pain relief and enhancing health-related quality of life in patients with metastatic spinal tumors. When performed to treat lesions of the upper thoracic spine, kyphoplasty poses certain technical challenges because of the smaller size of the pedicle and vertebral bodies. Fluoroscopic visualization is also difficult due to interference of the shoulder. The authors' objective in the present study was to evaluate their approach and the results of balloon kyphoplasty in the upper thoracic spine in patients with metastatic spinal disease. Methods Fourteen patients underwent kyphoplasty via an extrapedicular approach to treat metastatic tumors in the upper (T1–5) thoracic spine. Electrodiagnostic monitoring (somatosensory and motor evoked potentials) was used in 5 cases. Three levels were treated in 7 cases, 2 levels in 2 cases, and 1 level in 5 cases. In 3 cases access was bilateral, whereas in 11 cases access was unilateral. The procedure took an average of 25 minutes per treated level, and the mean amount of cement applied was 3 ml per level. Four patients were discharged from the hospital on the day of the procedure, and 10 patients went home after 24 hours. Results All patients exhibited marked improvement in mean visual analog scale scores (preoperative score 79 vs postoperative score 30, respectively) and Oswestry Disability Index scores (83 vs 33, respectively). The mean kyphotic angle was 25.03° preoperatively, whereas the mean postoperative angle was 22.65° (p > 0.3). At latest follow-up, the mean kyphotic angle did not differ significantly from the postoperative kyphotic angle (26.3°, p > 0.1). No neurological deficits or lung-related complications (pneumothorax or hemothorax) were encountered in any of the patients. Polymethylmethacrylate cement extravasations were observed in 3 (10%) of 30 treated vertebral bodies without any sequelae. By a mean follow-up of 16 months, no patients had experienced an adjacent-level fracture. Conclusions Balloon kyphoplasty of the upper thoracic spine via an extrapedicular approach is an efficient and safe minimally invasive procedure that may provide immediate and long-term pain relief and improvement in functional ability. It is technically challenging and has the potential for serious complications. With a fundamental knowledge of anatomy, as well as an ability to interpret fluoroscopy images, one can feasibly and safely perform balloon kyphoplasty in the upper thoracic spine.

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Percutaneous balloon kyphoplasty, a good minimally invasive surgical option for osteoporotic thoracolumbar compression fracture

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i2.36627 ◽

2018 ◽

Vol 11 (2) ◽

pp. 199

Author(s):

Md. Anowarul Islam ◽

Manish Shrestha ◽

Santosh Batajoo ◽

Dipendra Mishra ◽

Khandaker Hafijur Rahman

Keyword(s):

Minimally Invasive ◽

Operating Time ◽

Compression Fracture ◽

Balloon Kyphoplasty ◽

Functional Evaluation ◽

Vertebral Height ◽

Kyphotic Angle ◽

Vas Score ◽

Surgical Option

<p>The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.</p>

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Application of Anchoring Technique in Unilateral Percutaneous Vertebroplasty for Neurologically Intact Kümmell’s Disease

Pain Research and Management ◽

10.1155/2020/4145096 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Rongqing Qin ◽

Xing Zhang ◽

Hongpeng Liu ◽

Bing Zhou ◽

Pin Zhou ◽

...

Keyword(s):

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Kyphotic Angle ◽

Anterior Border ◽

Radiographic Measurements ◽

Kummell’S Disease ◽

Neurologically Intact ◽

Anchoring Technique ◽

Kümmell’S Disease

Purpose. We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell’s disease. Methods. From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell’s disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results. All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P<0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P<0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions. We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell’s disease.

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Kümmell's Disease Treated with Percutaneous Vertebroplasty: Minimum 1 Year Follow-Up

Korean Journal of Neurotrauma ◽

10.13004/kjnt.2017.13.2.119 ◽

2017 ◽

Vol 13 (2) ◽

pp. 119 ◽

Cited By ~ 5

Author(s):

Jae Won Park ◽

Jong-Hwa Park ◽

Hong Jun Jeon ◽

Jong Young Lee ◽

Byung Moon Cho ◽

...

Keyword(s):

Percutaneous Vertebroplasty ◽

Kummell’S Disease ◽

Kümmell’S Disease

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Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

10.21203/rs.3.rs-273357/v1 ◽

2021 ◽

Author(s):

Hao Cheng ◽

Guo-dong Wang ◽

Tao Li ◽

Xiao-yang Liu ◽

Jian-min Sun

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Sagittal Balance ◽

Rating Scale ◽

Clinical Results ◽

Spinal Alignment ◽

Thoracolumbar Kyphosis ◽

Kummell’S Disease ◽

Kümmell’S Disease

Abstract Background: To evaluate the short to mid-term radiographic and clinical outcomes of the restoration of normal spinal alignment and sagittal balance in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods: Between February 2016 and May 2018,30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into two groups (A and B) according to whether the kyphosis was combined with neurological deficits.All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance.And the radiographic outcomes and clinical results of these 30 patients were retrospectively evaluated.The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS)of the whole spine before operation,immediately after operation,and the last follow-up of each group were measured and evaluated.The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups .Results: The average follow-up period of group A and B were 34.2 and 38.7 months respectively.The parameters of both groups such as SVA,TLK,and thoracolumbar Cobb angle after surgery and at the last follow-up were significantly improved compared with those before surgery.The ODI and the NRS of the two groups at the last follow-up were also significantly improved. Conclusion: In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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