Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell's disease

Comparison of the Clinical Outcomes of Vesselplasty vs. Percutaneous Vertebroplasty for the Treatment of Neurologically Intact Osteoporotic Kümmell's Disease: A Retrospective Study

Kummell's disease (KD) is a rare clinical complication of osteoporotic vertebral compression fractures (OVCFs). Minimally invasive surgery is an important way to treat KD. In this paper, we used Percutaneous Vertebroplasty (PVP) and Vesselplasty (VP) to treat KD. 125 patients with KD were admitted to our hospital. Among them, 89 patients received PVP and 36 received VP. All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively. Postoperative Cobb angle of both groups postoperatively was lower than preoperatively (p < 0.05). The anterior height and ratio of vertebra compression of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in 16 vertebrae (16/89) in PVP group and one (1/36) in VP group. Two patients suffered from transient paraplegia in PVP group immediately after operation. Adjacent vertebral fractures occurred in one patient in PVP group and one in VP group. Re-fracture of affected vertebra occurred in one patient in PVP group. Besides, four patients suffered from bone cement loosening in PVP group while one in VP group. Both PVP and VP play an important effect in pain relief and functional recovery for the treatment of KD. And VP is more effective than PVP in preventing cement leakage.

The Use of Spiral Cement Injector for Percutaneous Vertebroplasty to Treat Kümmell Disease: A Retrospective Study

BACKGROUND

Percutaneous vertebroplasty (PVP) is a common method used to treat Kümmell disease. In patients without neurologic symptoms, we sought to evaluate whether using the new spiral injectors instead of the traditional push-rod injectors in PVP can result in improved clinical efficacy for the treatment of Kümmell disease.

METHODS

A clinical retrospective study was conducted between August 2018 and December 2020. The study included patients diagnosed with single-level thoracolumbar Kümmell disease who underwent PVP surgery. The patients were divided into 2 groups: an observation group consisting of 53 patients treated with spiral injectors and a control group consisting of 68 patients treated with push-rod injectors.

RESULTS

A 2-year follow-up period was adopted. The bone cement injection volume and occurrence of bone cement leakage were significantly greater in the observation group compared with the control group (P < 0.05). The observation group had significantly shorter operation time and intraoperative fluoroscopy times compared with the control group (P < 0.05). The scores for the visual analog scale and Oswestry Disability Index in both groups were significantly lower at 3 days or 3 months and 2 years after surgery compared with before surgery, with the scores at 2 years after surgery being significantly lower than those at 3 days or 3 months for both groups (P < 0.05). The relative anterior ledge height and Cobb angle showed significant improvement at 3 days and 2 years after surgery compared with before surgery in both groups (P < 0.05), but patients in the observation group experienced substantial improvement at 3 days and 2 years after surgery compared with those in the control group (P < 0.05). In both groups, the relative anterior ledge height was noticeably lower 2 years after surgery compared with 3 days after surgery (P < 0.05). Concurrently, there was a significant increase in the local Cobb angle over time in both groups (P < 0.05).

CONCLUSIONS

The implementation of both spiral injectors and traditional push-rod injectors in PVP surgery yields effective pain relief, improved function, partially restored vertebral height, and corrected kyphosis in treating Kümmell disease. Compared with the push-rod injector, the spiral injector is highly efficient in restoring vertebral height, correcting kyphosis, and minimizing fluoroscopy use and operation time, but it carries a greater risk of bone cement leakage.

Percutaneous short segmental fixation combined with bone cement augmentation for stage III Kümmell's disease without nerve deformity

The objective of this study was to evaluate the safety and efficacy of percutaneous pedicle screw fixation combined with bone cement augmentation in the management of stage III Kümmell disease without nerve deformity. A retrospective analysis was conducted on 17 patients diagnosed with stage III Kümmell disease without nerve deformity, who underwent treatment with percutaneous pedicle screw fixation combined with bone cement augmentation between April 2019 and 2022. Preoperative, postoperative, and final follow-up clinical outcome measures were collected, including Visual Analog Scale scores and Oswestry Disability Index scores. Additionally, lateral radiography was used to measure the Cobb angle and height of the anterior border of the affected vertebral body. Operative time, volume of injected bone cement, intraoperative cement leakage, and other complications were recorded. All patients underwent successful surgery, resulting in significant reductions in Visual Analog Scale scores, Oswestry Disability Index scores, and Cobb angle postoperatively; meanwhile there was a significant increase in height of the anterior border of the affected vertebral body. No major complications occurred during the follow-up period. In conclusion, percutaneous pedicle screw short-segment fixation combined with bone cement augmentation appears to be an effective surgical option for treating stage III Kümmell disease without nerve deformities.

Evaluation of the clinical efficacy of the bilateral pedicle cement anchoring technique in percutaneous vertebroplasty for Kümmell disease

The present study aimed to evaluate the clinical efficacy of the bilateral pedicle cement anchoring technique combined with the postural reduction in percutaneous vertebroplasty (PVP) for Kümmell disease. For this purpose, a retrospective study was performed on 18 patients with Kümmell disease who between January 2018 and June 2021 underwent bilateral pedicle cement anchoring combined with postural reduction in PVP. Pre- and post-operative bone mineral density, injected cement volume, visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements and anterior vertebral height (AVH) were recorded and assessed. The mean follow-up duration was 8.4±1.2 months. The average VAS score decreased from 8.17±0.71 pre-operatively to 1.56±0.62 post-operatively and remained at 2.00±0.91 at the final follow-up visit (P<0.05). The average ODI improved from 86.44±5.5 pre-operatively to 24.33±7.82 post-operatively. Until the last follow-up, the ODI remained at 27.11±8.76 (P<0.05). Similarly, the changes in the Cobb angle and AVH before and after surgery were also statistically significant in the radiological evaluation (P<0.05). During the follow-up, two patients experienced adjacent vertebral fractures. The loosening of cement was not found. Overall, the present study demonstrated that during the treatment of Kümmell disease with PVP, the bilateral pedicle cement anchoring technique combined with postural reduction can achieve good clinical outcomes.

Comparison of different approaches of percutaneous vertebroplasty in the treatment of osteoporotic spinal compression fractures and analysis of influencing factors of re-fracture

Objective

To compare the functional and radiological outcome of different approaches of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF), and to analyze the factors affecting postoperative re-fracture in patients with OVCF.

Methods

Medical data of 76 patients with OVCF who underwent PVP in our hospital from January 2021 to December 2021 were analyzed retrospectively. Based on the different intraoperative approaches, patients were divided into Unilateral-group (n=36) and Bilateral-group (n=40). The perioperative indexes, clinical efficacy, and spinal nerve function of the two groups were compared. Logistic regression analysis was used to determine the risk factors of postoperative re-fracture in patients with OVCF. The functional outcome was assessed with Oswestry disability index (ODI), American Spinal Injury Association (ASIA) nerve function classification and pain with Visual analogue scale (VAS). The radiological outcome was assessed by noting change of anterior vertebral height and change of kyphosis Cobb angle.

Results

The amount of intraoperative bleeding, the number of X-ray irradiation and the volume of injected bone cement in the Unilateral-group were lower, and the operation time was shorter than Bilateral-group (all P<0.05). One week after the operation, the anterior height of the vertebral body was higher, the Cobb angle of kyphosis was lower, the VAS score was higher, and the ASIA grade was lower in the Unilateral-group compared to the Bilateral-group (P<0.05). Logistic regression analysis showed that the age, bone mineral density, volume of bone cement injection and PD were risk factors of postoperative re-fracture in patients with OVCF.

Conclusion

Unilateral PVP treatment of OVCF has the advantages of less intraoperative bleeding, less X-ray irradiation and shorter operation time. At the same time, bilateral PVP is associated with improved bone cement dispersion, and the effect of improving patients' pain is better than that in the Unilateral PVP. Postoperative risk of re-fracture in OVCF patients correlated with age, bone mineral density, amount of bone cement injection and pedicle diameter.

Studies on Kyphoplasty over 20 years by science mapping method: Kyphoplasty by science mapping method

DESIGN

This is a bibliometric analysis. Performed by Scientific Mapping technique. The purpose of the study is to analyze articles on Kyphoplasty. Kyphoplasty is a minimally invasive surgical method. Bibliometrics is the mathematical and statistical quantitative analysis of works. One of the primary uses of bibliometric analysis is scientific mapping.

METHOD

To conduct the bibliometric analysis of the subject of Kyphoplasty, the Web of Science Core Collection database was preferred. After the selection of the data set, the data were filtered; as a result, the study was carried out on 2236 articles. Researchers, journals, articles, institutions, and the studies' countries were analyzed.

RESULTS

According to the number of articles published in Kyphoplasty, China, USA, Germany, Korea, and Italy are among the leading countries. According to the analysis, the authors with the highest h-index value are Yang HL and Hirsch JA. The European Spine Journal and the Spine are the most impactful journals.

CONCLUSIONS

Our study was carried out with the Science Mapping technique using Bibliometrics software. This type of work has become popular in recent years. Such studies are not common in the field of neurosurgery.

Comparative Efficacy of Three Minimally Invasive Procedures for Kümmell’s Disease: A Systematic Review and Network Meta-Analysis

Background

Percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and bone-filling mesh containers(BFC) are three viable minimally invasive techniques that have been used to treat Kümmell’s disease(KD). However, there is still debate as to which is safer and more effective. This study summarized the pros and cons of the three techniques in the treatment of KD through network meta-analysis(NMA).

Methods

All eligible published clinical control studies comparing PVP, PKP, and BFC for KD up to December 2021 were collected by online search of Cochrane Library, PubMed, Embase, CNKI, Wanfang Database, and Chinese biomedical literature database. Data were extracted after screening, and Stata 16.0 software was used to perform the network meta-analysis.

Results

Four randomized controlled trials (RCTs) and 16 retrospective case-control studies (CCTs) with a total of 1114 patients were included. The NMA results showed no statistical difference between the 3 procedures in terms of improving patients’ clinical symptoms. PKP was most likely to be the most effective in correcting kyphosis, while BFC was likely to be the most effective in managing the occurrence of cement leakage. No statistical differences were found in the incidence of new vertebral fractures in adjacent segments.

Conclusions

Ranking analysis showed that BFC has the highest likelihood of being the optimal procedure for the treatment of KD, based on a combined assessment of effectiveness in improving patients’ symptoms and safety in the occurrence of adverse events.

Does the Relationship Between Bone Cement and the Intravertebral Cleft of Kummell Disease Affect the Efficacy of PKP?

OBJECTIVE

To study the relationship between distribution of bone cement and intravertebral cleft of patients with Kummell disease on the clinical effect of percutaneous kyphoplasty (PKP).

METHODS

According to the relationship between the distribution of bone cement and the cleft in the vertebrae, a total of 92 patients with Kummell disease who underwent PKP in our hospital were divided into 2 groups. Specifically, the bone cement of patients in group A was localized in the cleft of the vertebrae and did not infiltrate around the cleft, while that of group B patients not only filled the cleft of the vertebrae, but also distributed diffusely around the cleft of the vertebrae. The amount of bone cement injected, leakage rate, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), and vertebral imaging changes before operation, and 2 days and 1 year after operation were compared between the 2 groups.

RESULTS

The amount of bone cement injected and the permeability of bone cement in group B were higher than those in group A (P < 0.05). The scores of VAS and ODI in both groups were significantly improved after operation, but the two scores in group B were better than those in group A one year after operation. The height of anterior vertebral body and Cobb's angle of kyphosis in the 2 groups were significantly improved after operation, but 1 year after operation, those in group B were better than those in group A.

CONCLUSIONS

PKP was an effective method for treating Kummell disease. At the same time, the relationship between the distribution of bone cement and the cleft in the vertebral body was an important factor affecting the curative effect after PKP. The effect of the distribution pattern of bone cement filled with intravertebral cleft and diffusely distributed around the fissures was better than that of bone cement confined in the vertebral cleft.

Clinical Efficacy of Percutaneous Kyphoplasty Combined with Calcitriol and Calcium in the Treatment of Traumatic Nonosteoporotic Vertebral Compression Fractures

Objective

The present study investigated the clinical efficacy of percutaneous kyphoplasty (PKP) combined with calcitriol and calcium in the treatment of traumatic nonosteoporotic vertebral compression fractures (TNVCFs).

Methods

The patients were equally divided into a control group and a treatment group by a random number table. The patients in the control group underwent PKP surgery, and the patients in the treatment group received calcitriol and calcium on the basis of PKP surgery. The visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI) scores, the height of the anterior edge of the vertebral body, Cobb's angle, and the level of the bone mineral density of the two groups of TNVCF patients before surgery were recorded and compared, one and six months after surgery.

Results

Thirty-six inpatients with TNVCFs admitted to the trauma center of the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were recruited. There were no significant differences in the VAS and ODI scores, the height of the anterior edge of the injured vertebral body, Cobb's angle, and bone mineral density between the two groups before surgery (P > 0.05). The VAS scores, ODI scores, the height of the anterior edge of the injured vertebral body, and Cobb's angle of the two groups of patients after surgery were significantly better than those before surgery. One and six months after surgery, the VAS and ODI scores, the height of the anterior edge of the injured vertebral body, Cobb's angle, and the bone mineral density of the patients in the treatment group improved significantly compared to those in the control group (P < 0.05).

Conclusions

PKP combined with calcitriol and calcium medications could significantly relieve pain, alleviate the loss of compressed vertebral height and kyphosis, and improve the spinal function and the life quality of the TNVCF patients.

Outcome after Posterior Vertebral Column Resection in Patients with Severe Osteoporotic Fractures—A Retrospective Analysis from Two Centers

Background and Objectives: In osteoporotic fractures of the spine with resulting kyphosis and threatening compression of neural structures, therapeutic decisions are difficult. The posterior vertebral column resection (pVCR) has been described by different authors as a surgical treatment in a single-stage posterior procedure. The aim of this study is to evaluate midterm outcomes of patients treated by pVCR due to severe osteoporotic fractures. Materials and Methods: Retrospective data analysis of all the patients treated for osteoporotic fractures by pVCR from 2012–2020 at two centers was performed. Demographic data, visual analog scale (VAS), Frankel scale (FS), Karnofsky performance status (KPS), radiological result and spinal fusion rates were evaluated. Results: A total of 17 patients were included. The mean age was 70 ± 10.2 y. The mean VAS decreased significantly from 7.7 ± 2.8 preoperatively to 3.0 ± 1.6 at last follow-up (p < 0.001) and the segmental kyphosis decreased from 29.4 ± 14.1° to 7.9 ± 8.0° (p < 0.001). The neurologic function on the FS did not worsen in any and improved in four of the patients. The median KPS remained stable over the whole observation period (70% vs. 70%). Spinal fusion was observed in nine out of nine patients who received CT follow-up >120 days after index surgery. Conclusions: This study showed that pVCR is a safe surgical technique with few surgical complications and no neurological deterioration considering the cohort. The patients’ segmental kyphosis and VAS improved significantly, while the KPS remained stable.

Efficacy and complications of different surgical modalities of treating osteoporotic spinal compression fracture in the elderly

PURPOSE

To explore the efficacy and complications of different surgical modalities in the treatment of osteoporotic spinal compression fractures (OSCFs) in the elderly.

METHODS

This retrospective study included 98 elderly patients with OSCFs who received surgical treatment in the Changsha Hospital of Traditional Chinese Medicine from March 2018 to July 2020. Based on different surgical treatments, the patients were divided into a percutaneous kyphoplasty (PKP) group (n=51) and a percutaneous vertebroplasty (PVP) group (n=47). The intraoperative blood loss, operation time, the amount of bone cement per vertebral body, length of hospitalization, and fracture healing time were recorded and compared between the two groups. The original anterior wall height and middle height of the compressed fractured vertebra were then evaluated and compared at 3 time points, namely before operation, 2 days after operation, and 6 months after operation. Pain, spinal function improvement and Cobb's angle were evaluated and compared between the two cohorts of patients before operation and 3 months after operation. Adverse reactions and bone cement permeability were recorded and compared between the two groups. Patients' quality of life quality was evaluated using the 36-Item Short-Form Health Survey (SF-36) before treatment and 12 months after treatment. Treatment satisfaction was evaluated.

RESULTS

Intraoperative blood loss, the average use of bone cement per vertebral body and length of hospitalization were similar between the groups (P>0.05). However, the PKP group had significantly longer operation time and fracture healing time than the PVP group (P<0.05). Vertebral 3D volume, as well as anterior wall and middle vertebra heights increased significantly at 6 months after surgery in both groups (all P<0.05). In addition, anterior wall and middle vertebra heights increased more in the PVP group than in the PKP group. The Visual Analogue Scale (VAS) and Oswesrty Disability Index (ODI) scores, as well as Cobb's angle decreased in both groups at 3 months after treatment (all P<0.05). The Cobb's angle and VAS score of the PVP group showed more significant reductions (all P<0.05). The PKP group had a higher incidence of adverse reactions and bone cement leakage rate than the PVP group (all P<0.05). However, no distinct difference was determined between the two groups in terms of patients' quality of life at 12 months after surgery. Treatment satisfaction was significantly higher in the PVP group than the PKP group.

CONCLUSION

For the treatment of senile OSCFs, both PVP and PKP have the advantages of little trauma and quick recovery. PVP has an edge over PKP with significantly shorter operation time, lower possibility of bone cement venous leakage and adjacent cone fracture, and higher surgical safety.

Intervertebral bridging ossification after kyphoplasty in a Parkinson’s patient with Kummell’s disease: A case report

BACKGROUND

The short-term therapeutic efficacy of kyphoplasty on Kummell’s disease is obvious. However, postoperative refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative refracture and adjacent vertebral fracture, providing new stability.

CASE SUMMARY

A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient’s VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient's back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.

CONCLUSION

Kyphoplasty is currently a conventional treatment for Kummell's disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.

Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures Associated with Spinal Canal Encroachment without Neurological Symptoms

Background

Percutaneous kyphoplasty (PKP) has been widely used for osteoporotic vertebral compression fractures (OVCFs). However, whether this approach is suitable for osteoporotic vertebral fractures with spinal canal encroachment remains controversial.

Material/Methods

Of 526 patients who underwent PKP at our hospital, 40 had conditions associated with spinal canal encroachment, and were enrolled in the study. Detailed physical, neurological, and radiological examinations were performed on each patient before and after surgery and at the followup. A visual analog scale (VAS) and the Oswestry Disability Index (ODI) were used for the clinical assessment. The vertebral body height, the local kyphosis, and the spinal canal width were used for the radiological evaluation.

Results

There were 11 male and 29 female patients, with a mean age of 71±8 years. The VAS score decreased from 6.4±0.7 preoperatively to 1.6±0.7 postoperatively and to 2.3±1.5 at the last followup visit. The ODI score was 78±9.5 before surgery, declined to 24±11.3 after surgery, and was 27.6±12.5 at the last followup visit. The vertebral body height increased from 11.7±4.3 mm to 14.6±4.4 mm. The local kyphosis decreased from 15.0±10.7 degrees preoperatively to 8.5±11.3 degrees postoperatively. The spinal canal width remained stable, at 8.5±2.0 mm before PKP and 8.7±1.9 after PKP.

Conclusions

PKP effectively relieved back pain in OVCF patients with spinal canal encroachment. Their social function improved as well.

Back Pain Due to Kummell's Disease

Kummell’s disease (KD) is a delayed post-traumatic avascular osteonecrosis of the vertebral body secondary to a vertebral compression fracture that can present with back pain. We discuss the importance of an accurate diagnosis and appropriate management of Kummell’s disease. Additionally, we aim to increase awareness and promote early diagnosis and treatment to prevent serious complications.

A 55-year-old man had been diagnosed with avascular necrosis (AVN) of both hips and had a history of trauma to the left hip ten years ago. Between the initial fall and subsequent presentation, he resumed independent physical activity. At approximately 10 months following his initial injury, he returned to a local emergency department with vague complaints of lower back pain. He was prescribed analgesics for pain and discharged. Subsequently, he experienced a progressive increase in pain and complained of motor deficits of the lower limbs. He presented to our emergency room with acute onset of worsening pain. Magnetic resonance imaging revealed multiple-level compression fractures and a fluid cleft in the L2 intervertebral disc. Surgery was advised, but he did not consent. Therefore, nonsurgical treatment included bed rest, wearing a brace, lumbar traction, analgesics, and medication to prevent osteoporosis.

Prompt, accurate diagnosis of Kummell’s disease is important for timely, appropriate treatment, which can improve quality of life and prevent comorbidities.