Treatment of stage Ⅲ Kümmell disease with short segment bone cement screw fixation combined with vertebroplasty

English Keywords:Short segment fixation  Vertebroplasty  Kümmell′s disease

English Abstract:

  【Abstract】 Objectives: To investigate the feasibility and effect of short segment bone cement screw fixation combined with vertebroplasty for stage Ⅲ Kümmell disease. Methods: A retrospective analysis of 20 hospitalized patients with stage Ⅲ Kümmell disease treated by the combination of short segment bone cement screw fixation and vertebroplasty from January 2014 to June 2016 was reviewed retrospectively. Among them, there were 3 males and 17 females, aged 58-93 years, with an average age of 73.0±8.4 years. The course of disease was 16-54 weeks, averaging 22.4±11.7 weeks. According to the American Spinal Injury Association(ASCI) grade, 1 case was graded as C level, 5 cases as D level, 14 cases as E level. The visual analogue scale(VAS) score, Oswestry disability index(ODI) score were used for assessment, at the same time the X-ray results of anterior height of injured vertebra body, the Cobb of kyphosis angle and the complications at preoperation, 1 week after operation and at the final follow-up were recorded to evaluate the outcome. Results: All the patients underwent the operation successfully. The operation time was 187.65±51.84min, the amount of bleeding was 374.00±198.00ml, the injured vertebra bone cement injection volume was 4.43±0.86ml, the hospital stay was 18.65±8.39d. 5 cases were noted bone cement leakage. Among them, 2 cases were noted leakage in front of the vertebral body, at lateral side in 1 case, 1 case in the upper end plate and 1 case in the disc space, no nerve and spinal cord related symptoms were noted. After surgery, all cases were followed up for 12-24 months, with an average of 17.34±2.41 months. The VAS score decreased from preoperative 7.30±0.98 to 3.65±0.67 points 1 week after operation, and 1.55±0.83 points at final follow-up. The ODI score decreased from preoperative (67.05±6.21)% to (34.95±5.35)% 1 week after operation, and (18.60±3.99)% at final follow-up. The anterior height of injured vertebra body decreased from preoperative 14.42±2.33mm to 21.00±1.84mm 1 week after operation, and 20.93±1.83mm at final follow-up. The Cobb of kyphosis angle decreased from preoperative 23.37°±6.58° to 12.27°±2.79° 1 week after operation, and reached 12.26°±2.84° at final follow-up. At the final follow-up, 3 cases reached D level, 17 cases to E level. During the follow-up, no instrument failure was noted. Conclusions: The combination of short segment bone cement screw fixation and vertebroplasty can alleviate the symptoms of stage Ⅲ Kümmell disease, effectively restore the sagittal alignment of spine, better correct the kyphosis, maintain the height and strength of the injured vertebra body.