Transpedicular impaction bone grafting combined with long segmental posterior instrumentation in treating stage Ⅲ Kümmell′s disease

English Keywords:Kümmell′s disease  Transpedicular impaction bone grafting  Pedicle screw fixation  Efficacy

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy of transpedicular impaction bone grafting combined with long segmental pedicle screw fixation in treating stage Ⅲ Kümmell′s disease． Methods: This retrospective study comprised a consecutive series of a total of 24 patients with stage Ⅲ Kümmell′s disease, including 5 males and 19 females with ages ranging from 58-81 years(an average age of 67.3±3.5 years). They were treated by posterior transpedicular impaction bone grafting combined with long segmental pedicle screw fixation(two or more segments of above/below injury vertebrae were fixed, transpedicular bone cement injection were used in 6 osteoporotic patients) from August 2011 to December 2015 in our hospital. The mean operation time and blood loss were collected. The clinical outcome was evaluated by using the visual analogue scale(VAS) and the Oswestry disability index(ODI) at preoperation, one-week postoperation and final follow-up. X-ray and CT scan were used to evaluate the anterior vertebral body height of the injured vertebra, the segmental kyphosis and bone graft healing status preoperatively, at one-week postoperation and final follow-up. Complication events were also analyzed. Results: All patients were followed up for 15 to 62 months(31.6±1.8 months). The average operation time was 142.6±21.5min(110-180min). Mean operative blood loss was 290.3±51.2ml(220-410ml). VAS score of preoperation, 1 week postoperation and final follow-up was 7.2±1.8, 3.2±1.1, 2.9±0.7 respectively; ODI score was (83.5±3.8)%, (32.6±2.6)%, (29.8±1.9)% respectively; anterior vertebral height was 13.2±1.3mm, 20.6±2.1mm, 19.8±2.3mm respectively; kyphosis was 28.1°±2.3°, 6.3°±0.9°, 7.6°±0.6° respectively． The VAS score, ODI score, anterior vertebral height and vertebral kyphosis were significantly different between preoperation and one week after operation(P<0.05). But there was no significant difference in anterior vertebral height and vertebral kyphosis between one week after operation and final follow-up(P>0.05), which suggested that there was no vertebral collapse or loss of correction in kyphosis at final follow-up. Conclusions: Posterior transpedicle intracorporeal bone grafting combined with long segmental posterior instrumentation is an efficient strategy in treating stage Ⅲ Kümmell′s disease, which can correct kyphosis and restore the vertebral body height.