Clinical application of an improved classification system of Kümmell’s disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yun ¹ , GAO Guan ² , WANG Lei ³ , LI Zhichao ³ , DONG Jianwen ³ ,  XUE Jingcai ³

1. College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250001, P.R.China;
2. Department of Orthopedics, Weihaiwei People’s Hospital, Weihai Shandong, 264200, P.R.China;
3. Department of Orthopedics, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250001, P.R.China;

Corresponding?author：

XUE Jingcai, Email: 826067299@qq.com

Keywords：

Kümmell’s disease; modified classification system; treatment; clinical application

DOI：

10.7507/1002-1892.202010042

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Objective To report an improved classification system of Kümmell’s disease and its clinical application.Methods Based on CT and MRI, an improved classification system of Kümmell’s disease was proposed in terms of the integrity of sagittal endplate, the integrity of posterior wall of vertebral body, and the degree of vertebral compression. Between January 2011 and March 2018, the improved classification system was used to evaluate and guide the treatment of 78 patients with Kümmell’s disease. There were 13 males and 65 females. The mean age was 69.1 years (range, 54-85 years). The mean disease duration was 4.0 months (range, 1-8 months). The mean T value of bone mineral density was ?3.66 (range, ?3.86- ?3.34).The fractures located at thoracic vertebrae in 47 cases and lumbar vertebrae in 31 cases. According to the modified classification system of Kümmell’s disease, there were 11 cases of type A1, 13 cases of type A2, 2 cases of type A3, 10 cases of type B1, 18 cases of type B2, 4 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 11 cases of type C3. According to the classification results, the patients of types A and B were treated with percutaneous kyphoplasty (PKP), while the patients of type C were treated with PKP or intra- vertebral fixation according to the degree of vertebral reduction. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate clinical efficacy. The heights of the anterior, middle, and posterior edges of the vertebrae and the Cobb angle were measured to evaluate the reduction of the injured vertebrae and the improvement of kyphosis deformity. The complications were recorded.Results The statistical analysis showed that the improved classification system has good consistency. All patients were followed up 12-36 months (mean, 24.3 months). The heights of anterior, middle, and posterior edges of the vertebrae, Cobb angle, VAS score, and ODI of all types of patients at last follow-up showed significant differences when compared with those before operation (P<0.05). After operation, 4 patients of type A2 had different degree of vertebral height loss; 2 patients of type B2, 3 patients of type C1, and 2 patients of type C2 developed asymptomatic bone cement leakage during PKP; 2 patients of type B3 and 3 patients of type C2 underwent percutaneous internal fixation and vertebral augmentation due to bone cement loosening.Conclusion The modified classification system of Kümmell’s disease can be used to guide treatment of Kümmell’s disease, but the number of clinical application cases is limited, and further application and observation are needed.

Citation： ZHANG Yun, GAO Guan, WANG Lei, LI Zhichao, DONG Jianwen, XUE Jingcai. Clinical application of an improved classification system of Kümmell’s disease. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 464-470. doi: 10.7507/1002-1892.202010042 Copy

1.	趙健博, 侯勇, 司萌. Kummell 病的診治進展. 創傷外科雜志, 2019, 21(9): 641-644.
2.	Lim J, Choi SW, Youm JY, et al. Posttraumatic delayed vertebral collapse: Kummell’s disease. J Korean Neurosurg Soc, 2018, 61(1): 1-9.
3.	李江筆, 那士博, 公偉權, 等. Kümmell 病的臨床治療進展. 中國骨傷, 2020, 33(1): 81-86.
4.	Zhang J, Fan Y, He X, et al. Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell’s disease? A comparison of two minimally invasive procedures. Int Orthop, 2018, 42(6): 1321-1326.
5.	王慶德, 梅偉, 張振輝, 等. 經椎弓根打壓植骨聯合后路長節段固定治療Ⅲ期 Kümmell 病. 中國脊柱脊髓雜志, 2018, 28(6): 522-528.
6.	Steel HH. Kümmell’s disease. Am J Surg, 1951, 81(2): 161-167.
7.	Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Musculoskel Res, 2004, 8(1): 43-55.
8.	Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4): 883-891.
9.	葛朝元, 何立民, 鄭永宏, 等. Kümmell 病新分型系統評估及臨床應用. 中國脊柱脊髓雜志, 2017, 27(4): 312-319.
10.	Wang W, Liu Q, Liu WJ, et al. Different performance of intravertebral vacuum clefts in Kümmell’s disease and relevant treatment strategies. Orthop Surg, 2020, 12(1): 199-209.
11.	唐永超, 張順聰, 梁德, 等. 應用過伸位 CT 重建預判椎體強化術治療Ⅲ期可復型 kümmell’s 病. 廣東醫學, 2016, 37(14): 2116-2119.
12.	Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
13.	劉鍵, 李明東, 陳科, 等. 影像學及 PKP 在 Kümmell 病診療中運用的相關研究. 中國實驗診斷學, 2019, 23(9): 1584-1586.
14.	Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
15.	Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189): 65-76.
16.	薛海鵬, 吳燕, 徐展望, 等. 骨填充囊袋結合體位復位治療老年 kümmell 病. 中國矯形外科雜志, 2018, 26(3): 271-274.
17.	劉義杰, 楊森, 李雪峰, 等. 經皮椎體后凸成形術治療無神經癥狀性Ⅲ期 Kümmell 病. 中華創傷骨科雜志, 2019, 21(10): 888-893.
18.	Yang DL, Yang SD, Chen Q, et al. The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: minimum of one-year follow-up. Med Sci Monit, 2017, 23: 606-612.
19.	陳伯華, 丁文元, 陳其昕, 等. 機器人導航系統聯合 3D 打印技術輔助經皮椎體成形術治療 Kümmell 病的療效. 中華創傷雜志, 2020, 36(9): 797-803.
20.	路文超, 王宇鵬, 湛川. 椎體后凸成形治療 Kummell 病過程中發生的骨水泥滲漏. 中國組織工程研究, 2019, 23(2): 172-177.
21.	劉飛俊, 樓超, 金康濤, 等. 經皮后路內固定聯合經皮椎體成形術治療 Kümmell 病繼發節段不穩定的短期療效. 中華創傷雜志, 2020, 36(5): 414-420.
22.	Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebralcollapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
23.	Nakashima H, Imagama S, Yukawa Y, et al. Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976), 2015, 40(2): E120-126.
24.	Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J, 2006, 6(5): 479-487.

1. 趙健博, 侯勇, 司萌. Kummell 病的診治進展. 創傷外科雜志, 2019, 21(9): 641-644.
2. Lim J, Choi SW, Youm JY, et al. Posttraumatic delayed vertebral collapse: Kummell’s disease. J Korean Neurosurg Soc, 2018, 61(1): 1-9.
3. 李江筆, 那士博, 公偉權, 等. Kümmell 病的臨床治療進展. 中國骨傷, 2020, 33(1): 81-86.
4. Zhang J, Fan Y, He X, et al. Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell’s disease? A comparison of two minimally invasive procedures. Int Orthop, 2018, 42(6): 1321-1326.
5. 王慶德, 梅偉, 張振輝, 等. 經椎弓根打壓植骨聯合后路長節段固定治療Ⅲ期 Kümmell 病. 中國脊柱脊髓雜志, 2018, 28(6): 522-528.
6. Steel HH. Kümmell’s disease. Am J Surg, 1951, 81(2): 161-167.
7. Li KC, Wong TU, Kung FC, et al. Staging of Kümmell’s disease. J Musculoskel Res, 2004, 8(1): 43-55.
8. Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4): 883-891.
9. 葛朝元, 何立民, 鄭永宏, 等. Kümmell 病新分型系統評估及臨床應用. 中國脊柱脊髓雜志, 2017, 27(4): 312-319.
10. Wang W, Liu Q, Liu WJ, et al. Different performance of intravertebral vacuum clefts in Kümmell’s disease and relevant treatment strategies. Orthop Surg, 2020, 12(1): 199-209.
11. 唐永超, 張順聰, 梁德, 等. 應用過伸位 CT 重建預判椎體強化術治療Ⅲ期可復型 kümmell’s 病. 廣東醫學, 2016, 37(14): 2116-2119.
12. Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
13. 劉鍵, 李明東, 陳科, 等. 影像學及 PKP 在 Kümmell 病診療中運用的相關研究. 中國實驗診斷學, 2019, 23(9): 1584-1586.
14. Kim DY, Lee SH, Jang JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg, 2004, 100(1 Suppl Spine): 24-31.
15. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189): 65-76.
16. 薛海鵬, 吳燕, 徐展望, 等. 骨填充囊袋結合體位復位治療老年 kümmell 病. 中國矯形外科雜志, 2018, 26(3): 271-274.
17. 劉義杰, 楊森, 李雪峰, 等. 經皮椎體后凸成形術治療無神經癥狀性Ⅲ期 Kümmell 病. 中華創傷骨科雜志, 2019, 21(10): 888-893.
18. Yang DL, Yang SD, Chen Q, et al. The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: minimum of one-year follow-up. Med Sci Monit, 2017, 23: 606-612.
19. 陳伯華, 丁文元, 陳其昕, 等. 機器人導航系統聯合 3D 打印技術輔助經皮椎體成形術治療 Kümmell 病的療效. 中華創傷雜志, 2020, 36(9): 797-803.
20. 路文超, 王宇鵬, 湛川. 椎體后凸成形治療 Kummell 病過程中發生的骨水泥滲漏. 中國組織工程研究, 2019, 23(2): 172-177.
21. 劉飛俊, 樓超, 金康濤, 等. 經皮后路內固定聯合經皮椎體成形術治療 Kümmell 病繼發節段不穩定的短期療效. 中華創傷雜志, 2020, 36(5): 414-420.
22. Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebralcollapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
23. Nakashima H, Imagama S, Yukawa Y, et al. Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976), 2015, 40(2): E120-126.
24. Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J, 2006, 6(5): 479-487.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of an improved classification system of Kümmell’s disease

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