Clinical efficacy of percutaneous kyphoplasty in the treatment of Kummell disease_West China Medical Journal

Authors：

YU Yang ^1,2 ,  FAN Haiquan ¹ , CHEN Ming ¹

1. Department of Spinal Surgery, Chengdu 416 Hospital, Chengdu, Sichuan 610051, P. R. China;
2. Department of Orthopedics, Sichuan Academy of Medical Sciences & ?Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding?author：

FAN Haiquan, Email: fhq007@sina.com

Keywords：

Kummell disease; Percutaneous kyphoplasty; Osteoporosis; Intravertebral vacuum cleft; Visual Analogue Scale; Oswestry Disability Index

DOI：

10.7507/1002-0179.201604162

Video：

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Objective To explore the clinical efficacy and safety of percutaneous kyphoplasty (PKP) in the treatment of Kummell disease. Methods We retrospectively analyzed the clinical data of 11 patients with Kummell disease treated by PKP between January 2013 and January 2016. There were 8 males and 3 females with an average age of 72.3 years old ranging from 64 to 78. The injured vertebra was located at T₁₁ in 2 patients, T₁₂ in 3, and L₁ in 6. All the patients suffered from lower back pain for 2.5-15.0 months averaging 7.6 months. Preoperative CT and MRI examinations showed that there were clear signs of intravertebral vacuum cleft and abnormal fluid signals. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the height and kyphotic angle of the injured vertebral body were measured to evaluate the clinical outcomes before and after surgery. Results Follow-up was conducted for all 11 patients. Cement leakage occurred in 4 patients with no symptoms. The vertebral height, Cobb angel of the injured vertebra, VAS and ODI improved significantly after surgery and during the latest follow-up. Compared with those parameters after surgery, only VAS score was different during the latest follow-up. Conclusion PKP is safe and effective in the treatment of Kummell disease.

Citation： YU Yang, FAN Haiquan, CHEN Ming. Clinical efficacy of percutaneous kyphoplasty in the treatment of Kummell disease. West China Medical Journal, 2017, 32(4): 524-528. doi: 10.7507/1002-0179.201604162 Copy

1.	?李停, 宋建東. 經皮球囊擴張椎體后凸成形術治療骨質疏松性椎體壓縮性骨折骨水泥滲漏的預防. 武漢大學學報: 醫學版, 2014, 35(2): 314-317.
2.	Huskisson EC. Measurement of pain. Lancet, 1974, 2(7889): 1127-1131.
3.	Fairbank JC, Couper J, Davies JB, et al. The Oswestry low back pain disability questionnaire. Physiotherapy, 1980, 66(8): 271-273.
4.	Young WF, Brown D, Kendler A, et al. Delayed post-traumatic osteonecrosis of a vertebral body (Kummell’s disease). Acta Orthop Belg, 2002, 68(1): 13-19.
5.	Konstantinou D, Velissaris D, Panagiotopoulos E. Kümmell’s disease: is ischemic necrosis or vertebral " microcracking” the first step in the sequence?. Med Hypotheses, 2013, 80(4): 505.
6.	Fabbriciani G, Pirro M, Floridi P. Osteoanabolic therapy: a non-surgical option of treatment for Kümmell’s disease?. Rheumatol Int, 2012, 32(5): 1371-1374.
7.	Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of Intravertbral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
8.	Benedek TG, Nicholas JJ. Delayed traumatic vertebral body compression fracture, part Ⅱ: pathologic features. Semin Arthritis Rheum, 1981, 10(4): 271-277.
9.	Prabhu LV, Saralaya VV, Pai MM, et al. Vertebral body Integrity: a review of various anatomical factors Involved in the lumbar region. Osteoporos Int, 2007, 70(4): 891-903.
10.	Theodorou DJ. The intravertebral vacuum clfeft sign. Radiology, 2001, 221(3): 787-788.
11.	Yoon ST, Qureshi AA, Heller JG, et al. Kyphoplasty for salvage of a failed vertebroplasty in osteoporotic vertebral compression fractures: case report and surgical technique. J Spinal Disord Tech, 2005, 18 Suppl: S129-S134.
12.	何蔚, 青祖宏, 高巍. 球囊椎體后凸成形術與 Sky 膨脹式椎體成形術治療椎體壓縮性骨折的 Meta 分析. 解放軍醫學雜志, 2013, 38(4): 324-328.
13.	Wu MH, Huang TJ, Cheng CC, et al. Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study. BMC Musculoskelet Disord, 2010, 19(11): 164.
14.	Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.
15.	Peh WC, Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuumphenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
16.	Schofer MD, Efe T, Timmesfeld N, et al. Comparison of Kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg, 2009, 129(10): 1391-1399.
17.	Jung JY, Lee MH, Ahn JM. Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft. J Comput Assist tomogr, 2006, 30(3): 501.
18.	吳承鈞, 童培建, 厲駒, 等. 經皮球囊擴張椎體后凸成形術治療骨質疏松性椎體壓縮骨折近期療效分析. 中國中醫骨傷科雜志, 2011, 19(2): 10-15.
19.	王成, 尹紹猛, 傘有利, 等. 定向球囊技術在經皮椎體后凸成形術中的應用. 中國骨與關節損傷雜志, 2016, 31(3): 303-305.
20.	劉滔, 張志明, 史金輝, 等. 骨水泥溫度梯度灌注技術在經皮椎體后凸成形術中的應用. 中國脊柱脊髓雜志, 2015, 25(12): 1073-1078.

1. ?李停, 宋建東. 經皮球囊擴張椎體后凸成形術治療骨質疏松性椎體壓縮性骨折骨水泥滲漏的預防. 武漢大學學報: 醫學版, 2014, 35(2): 314-317.
2. Huskisson EC. Measurement of pain. Lancet, 1974, 2(7889): 1127-1131.
3. Fairbank JC, Couper J, Davies JB, et al. The Oswestry low back pain disability questionnaire. Physiotherapy, 1980, 66(8): 271-273.
4. Young WF, Brown D, Kendler A, et al. Delayed post-traumatic osteonecrosis of a vertebral body (Kummell’s disease). Acta Orthop Belg, 2002, 68(1): 13-19.
5. Konstantinou D, Velissaris D, Panagiotopoulos E. Kümmell’s disease: is ischemic necrosis or vertebral " microcracking” the first step in the sequence?. Med Hypotheses, 2013, 80(4): 505.
6. Fabbriciani G, Pirro M, Floridi P. Osteoanabolic therapy: a non-surgical option of treatment for Kümmell’s disease?. Rheumatol Int, 2012, 32(5): 1371-1374.
7. Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of Intravertbral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
8. Benedek TG, Nicholas JJ. Delayed traumatic vertebral body compression fracture, part Ⅱ: pathologic features. Semin Arthritis Rheum, 1981, 10(4): 271-277.
9. Prabhu LV, Saralaya VV, Pai MM, et al. Vertebral body Integrity: a review of various anatomical factors Involved in the lumbar region. Osteoporos Int, 2007, 70(4): 891-903.
10. Theodorou DJ. The intravertebral vacuum clfeft sign. Radiology, 2001, 221(3): 787-788.
11. Yoon ST, Qureshi AA, Heller JG, et al. Kyphoplasty for salvage of a failed vertebroplasty in osteoporotic vertebral compression fractures: case report and surgical technique. J Spinal Disord Tech, 2005, 18 Suppl: S129-S134.
12. 何蔚, 青祖宏, 高巍. 球囊椎體后凸成形術與 Sky 膨脹式椎體成形術治療椎體壓縮性骨折的 Meta 分析. 解放軍醫學雜志, 2013, 38(4): 324-328.
13. Wu MH, Huang TJ, Cheng CC, et al. Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study. BMC Musculoskelet Disord, 2010, 19(11): 164.
14. Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.
15. Peh WC, Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuumphenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
16. Schofer MD, Efe T, Timmesfeld N, et al. Comparison of Kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg, 2009, 129(10): 1391-1399.
17. Jung JY, Lee MH, Ahn JM. Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft. J Comput Assist tomogr, 2006, 30(3): 501.
18. 吳承鈞, 童培建, 厲駒, 等. 經皮球囊擴張椎體后凸成形術治療骨質疏松性椎體壓縮骨折近期療效分析. 中國中醫骨傷科雜志, 2011, 19(2): 10-15.
19. 王成, 尹紹猛, 傘有利, 等. 定向球囊技術在經皮椎體后凸成形術中的應用. 中國骨與關節損傷雜志, 2016, 31(3): 303-305.
20. 劉滔, 張志明, 史金輝, 等. 骨水泥溫度梯度灌注技術在經皮椎體后凸成形術中的應用. 中國脊柱脊髓雜志, 2015, 25(12): 1073-1078.

West China Medical Journal

Clinical efficacy of percutaneous kyphoplasty in the treatment of Kummell disease

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