J Korean Neurosurg Soc.  2015 Jul;58(1):54-59. 10.3340/jkns.2015.58.1.54.

Bone Cement-Augmented Percutaneous Short Segment Fixation: An Effective Treatment for Kummell's Disease?

• Park SJ
• Kim HS
• Lee SK
• Kim SW

• KMID: 2067105
• DOI: http://doi.org/10.3340/jkns.2015.58.1.54

Abstract

OBJECTIVE
The aim of this prospective study was to evaluate the efficacy of bone cement-augmented percutaneous short segment fixation for treating Kummell's disease accompanied by severe osteoporosis.
METHODS
From 2009 to 2013, ten patients with single-level Kummell's disease accompanied by severe osteoporosis were enrolled in this study. After postural reduction for 1-2 days, bone cement-augmented percutaneous short segment fixation was performed at one level above, one level below, and at the collapsed vertebra. Clinical results, radiological parameters, and related complications were assessed preoperatively and at 1 month and 12 months after surgery.
RESULTS
Prior to surgery, the mean pain score on the visual analogue scale was 8.5+/-1.5. One month after the procedure, this score improved to 2.2+/-2.0 and the improvement was maintained at 12 months after surgery. The mean preoperative vertebral height loss was 48.2+/-10.5%, and the surgical procedure reduced this loss to 22.5+/-12.4%. In spite of some recurrent height loss, significant improvement was achieved at 12 months after surgery compared to preoperative values. The kyphotic angle improved significantly from 22.4+/-4.9degrees before the procedure to 10.1+/-3.8degrees after surgery and the improved angle was maintained at 12 months after surgery despite a slight correction loss. No patient sustained adjacent fractures after bone cement-augmented percutaneous short segment fixation during the follow-up period. Asymptomatic cement leakage into the paravertebral area was observed in one patient, but no major complications were seen.
CONCLUSION
Bone cement-augmented percutaneous short segment fixation can be an effective and safe procedure for Kummell's disease.

Keyword

Osteonecrosis; Screw; Cement

MeSH Terms

Follow-Up Studies
Humans
Osteonecrosis
Osteoporosis
Prospective Studies
Spine

Figure

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  Fig. 1 The component of intravertebral cleft is divided into gas and fluid. A : Intravertebral gas at L1 level is a computed tomographic finding indicative of Kummell's disease. B : Intravertebral fluid filled cleft at L1 level on magnetic resonance imaging is also characteristic of Kummell's disease.

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  Fig. 2 Restoration of vertebral height. *Preoperative vs. 1 month, p=0.002, **Preoperative vs. 12 months, p=0.01.

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  Fig. 3 Changes in kyphotic angle. *Preoperative vs. 1 month, p=0.005, **Preoperative vs. 12 months, p=0.018.

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  Fig. 4 Improvement in pain score. *p<0.001, preoperative vs. final follow-up. VAS : visual analogue scale.

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  Fig. 5 Osteoporotic compression fracture with an intravertebral cleft at the T12 level in a 85-year-old female. A : T2-weighted magnetic resonance image reveals a fluid filled IVC, indicative of Kummell's disease. B and C : Simple radiographs after bone cement-augmented percutneous short segment screw fixation show restored vertebral height and improved kyphotic deformity in spite of cement leakage through venous channel (arrow). D and E : Simple radiographs taken at 12 months after surgery show some aggravation of kyphosis.

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  Fig. 6 Osteoporotic compression fracture with an intravertebral cleft (IVC) at the L1 level in a 83-year-old male. A : Computed tomography scan shows a gas filled IVC, indicative of Kummell's disease. B and C : Simple radiographs after bone cement-augmented percutaneous short segment screw fixation show restored vertebral height and improved kyphotic deformity. D and E : Simple radiographs taken at 12 months after surgery reveal a well-maintained kyphotic angle.

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