Korean J Neurotrauma.  2017 Oct;13(2):119-123. 10.13004/kjnt.2017.13.2.119.

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

Affiliations
  • 1Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. prinkipess@hanmail.net

Abstract


OBJECTIVE
To evaluate the radiographic and clinical outcomes of percutaneous vertebroplasty (PVP) in patients with Kümmell's disease.
METHODS
A retrospective review was conducted for 19 vertebrae in 18 patients, between January 2012 and June 2016. A visual analogue scale (VAS) score was used to determine each patient's subjective level of pain (0=no pain to 10=severe pain) preoperative, immediately postoperative and at the last follow-up (at least 12 months after PVP). Radiographic parameters such as regional and global kyphotic angle, lumbar lordosis (LL), thoracolumbar junction (TLJ) angle, vertebral height, cement leakage, refracture, and adjacent level fracture were evaluated by the clinician preoperative, immediate postoperative and at the last follow-up.
RESULTS
The mean VAS score significantly decreased after PVP and the decrease was maintained through to the final follow-up (p<0.05). However, the regional and global kyphotic angle, LL, and TLJ angle were not improved. Cement leakage was observed in 5 cases (26.3%): however, there were no cases of cement leakage into the spinal canal. No neurological deterioration was observed, even among patients with cement leakage. Adjacent level fractures were detected in 3 cases (15.8%).
CONCLUSION
PVP can be considered as an effective treatment option for pain relief and maintenance of sagittal balance in patients with Kümmell's disease.

Keyword

Bone cement; Kümmell's disease; Vertebroplasty

MeSH Terms

Animals
Follow-Up Studies*
Humans
Lordosis
Retrospective Studies
Spinal Canal
Spine
Vertebroplasty*

Figure

  • FIGURE 1 Magnetic resonance image (MRI) of Kümmell's disease. MRI of the lumbar spine shows a well-defined fluid signal intensity lesion surrounding dark rim with at L1 vertebral body. (A) Sagittal T2-weighted image (WI) showing band-like gas in the vertebral body. (B) Sagittal T1-WI showing a band-like low intensity signal. (C) Sagittal computed tomography image showing a recent compression fracture with retropulsion, and L1 intravertebral fluid and air-densities. (D) Sagittal X-ray image showing intravertebral gas cleft at L1.

  • FIGURE 2 A case of Kümmell's disease treated with percutaneous vertebroplasty. (A) There was acute vertebral body collapse and diminished vertebral height at L1. An intravertebral vacuum cleft (intravertebral vacuum phenomenon) was seen on a preoperative radiograph as a horizontal linear radiolucency within the L1 vertebral body. (B) Immediate postoperative lateral standing plain radiography showed a cement mass in the L1 vertebral body. Bone cement was injected to fill the gap and stabilize the fractured site. (C) At the 1-year follow-up, a lateral standing plain radiography image showed no cement leakage and no adjacent vertebral body fracture. Bone cement was filled into the injection site.


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