Treatment outcome of stage Ⅲ Kümmell′s disease by placing intra-vertebral cage via transpedicular tunnel

English Keywords:Kümmell′s disease  Pedicle  Cage  Spinal instrumentation  Spinal fusion

English Abstract:

  【Abstract】 Objectives: To investigate the feasibility and effects of implanting intra-vertebral cage through transpedicular tunnel in the treatment of stage Ⅲ Kümmell′s disease. Methods: A total of 8 patients diagnosed with stage Ⅲ Kümmell′s disease and treated by minimally invasive technique of intra-vertebral cage through transpedicular tunnel combined with posterior spinal stabilization in the Department of Orthopaedics of Qilu Hospital of Shandong University from January 2018 to January 2022 were enrolled in this study. There were 3 males and 5 femals, aged 68.9±6.2 years(59-78 years) old. The Oswestry disability index(ODI) and visual analogue scale(VAS) score of low back pain before operation, 3d after operation and half a year of follow-up were collected, and the Cobb angle and sagittal fracture vertebral body height ratio(anterior/posterior edge) before operation, after operation and half a year of follow-up were also measured to evaluate the clinical effect. Results: The VAS score of patients at postoperative 3d(6.00±1.31) and half a year(1.25±1.04) were significantly lower than that before operation(7.75±1.04)(P<0.05). The ODI of the patients at postoperative 3d[(47.00±6.68)%] and half a year[(10.25±5.70)%] recovered significantly from that before operation[(64.63±6.35)%](P<0.001). The Cobb angle at postoperative 3d(13.93°±3.69°) was significantly decreased than that at preoperation(36.89°±11.09°)(P<0.001), and no significant difference was found between that at half a year follow-up(13.15°±3.88°) and postoperative 3d(P=0.689). The vertebral height ratio(anterior/posterior edge) of fracture at sagittal plane was significantly improved at postoperative 3d(0.94±0.03) from that at preoperation(0.57±0.17)(P<0.001), and there was no significant difference between that at postoperative half a year(0.93±0.03) and postoperative 3d(P=0.463). All the 8 patients with stage Ⅲ Kümmell′s disease were relieved of pain after operation, with satisfactory recovery of the anterior column height of the vertebral body and significant improvement of kyphosis deformity, and the loss of vertebral height during follow-up was small[(3.18±2.66)%]. Conclusions: Intra-vertebral cage implantation via pedicle tunnel has the advantages of kyphosis correction and bone fusion promotion, which is therefore an optimal choice for the treatment of stage Ⅲ Kümmell′s disease.