Mid-to-long term efficacy analysis of percutaneous vertebral augamentation applied on the Kümmell′s disease without neurological deficit

English Keywords:Kümmell disease  Percutaneous vertebral augmentation  Osteoporosis

English Abstract:

  【Abstract】 Objectives: To evaluate the mid-long term efficacy and safety of percutaneous vertebral augmentation(PVA) applied on the Kümmell′s disease without neurological deficit. Methods: From June 2009 to June 2013, 32 patients(4 males and 28 females, 69.95±7.72 years old on average) with Kümmell′s disease of non-neurological deficit receiving percutaneous vertebral augmentation were reviewed. The average T score of bone mineral density was -3.43±0.22SD. The radiological variations including the Cobb angle, anterior and middle height of index vertebra and the type of bone-cement distribution obtained from X-ray were recorded preoperatively, at 3 days postoperatively and the final follow-up. Meanwhile, the visual analogue scale(VAS) and Oswestry disability index(ODI) scores were also evaluated. Results: The average follow-up time was 2.81±0.97 years(2-6 years). 7 cases were observed with asymptomatic bone-cement leakage. The vertebral height and the Cobb angle significantly improved after operation(P＜0.05), however, aggravated at the final follow-up(P＜0.05). The ODI and VAS scores decreased significantly after operation(P＜0.05), but increased a little without significant difference at the final follow-up compared with those at 3 days postoperatively. In addition, three types of morphological changes of bone-cement vertebrae were detected: (1)spontaneous fusion with adjacent vertebrae occurring in all cases; (2)cement fragmentation or migration found in 6 cases; (3)bright lines found in 8 cases. Conclusions: PVA in treatment of the Kümmell′s disease without neurological deficit abtains a significant short-term efficacy. However, PVA is unable to provide adequate stability in mid-long term follow-up，due to the height loss and kyphosis of the index vertebra aggravating. Close follow-up is mandatory.