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Ma X, Feng Q, Zhang X, Sun X, Lin L, Guo L, An L, Cao S, Miao J. Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel's disease in porcine vertebrae. Front Bioeng Biotechnol 2023; 11:1218478. [PMID: 37476480 PMCID: PMC10354293 DOI: 10.3389/fbioe.2023.1218478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objective: Treatment of Kümmel's Disease (KD) with pure percutaneous kyphoplasty carries a greater likelihood of bone cement displacement due to hardened bone and defect of the peripheral cortex. In this study, we designed a novel minimally invasive pedicle bone cement screw and evaluate the effectiveness and safety of this modified surgical instruments in porcine vertebrae. Methods: 18 mature porcine spine specimens were obtained and soaked in 10% formaldehyde solution for 24 h. 0.5000 mmol/L EDTA-Na2 solution was used to develop in vitro osteoporosis models of porcine vertebrae. They were all made with the bone deficiency at the anterior edge of L1. These specimens were randomly divided into 3 groups for different ways of treatment: Group A: pure percutaneous kyphoplasty (PKP) group; Group B: unilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group; Group C: bilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group. The MTS multi-degree of freedom simulation test system was used for biomechanical tests, including axial loading of 500 N pressure, range of motion (ROM) in flexion, extension, left/right lateral bending, and left/right axial rotation at 5 Nm, and the displacement of bone cement mass at maximum angles of 5° and 10°. Result: The three groups were well filled with bone cement, no leakage or displacement of bone cement was observed, and the height of the vertebrae was higher than pre-operation (p < 0.05). In the left/right axial rotation, the specimens were still significantly different (p < 0.05) from the intact specimens in terms of ROM after PKP. In other directions, ROM of all group had no significant difference (p < 0.05) and was close to the intact vertebrae. Compared with PKP group, the relative displacement of bone cement in groups B and C was smaller (p < 0.05). Conclusion: In the in vitro animal vertebral models, the treatment of KD with the placement of novel pedicle minimally invasive bone cement screw combined with PKP can effectively restore the vertebral height, improve the stability of the affected vertebra and prevent the displacement of bone cement. Biomechanically, there is no significant difference between bilateral and unilateral fixation.
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Affiliation(s)
- Xiang Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Qing Feng
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xingze Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Xiaolei Sun
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Longwei Lin
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Lin Guo
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lijun An
- Chengde Medical College, Hebei, China
| | | | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
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Ko MJ, Lee BJ. Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review. Korean J Neurotrauma 2023; 19:32-41. [PMID: 37051029 PMCID: PMC10083447 DOI: 10.13004/kjnt.2023.19.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.
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Affiliation(s)
- Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Impending cauda equina syndrome due to Kummell disease; A case report and literature review. Int J Surg Case Rep 2021; 83:106041. [PMID: 34118526 PMCID: PMC8193131 DOI: 10.1016/j.ijscr.2021.106041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Kummell disease (KD) is a rare cause of vertebral fracture due to osteonecrosis. The natural history of the disease is characterized by a previous minor trauma, a subclinical window period, and then a symptomatic period presenting with disabling pain, kyphosis, or neurologic deficit. Importance As an important but rare cause of non-discogenic cauda equina syndrome. Case presentation Here, we report on a wheelchair-bound 28-years-old bodybuilder man with KD who presented with progressive paresthesia and weakness of both legs (impending cauda equina syndrome) due to L5 involvement. He had a past medical history of arbitrary use of licensed and unlicensed drugs in the fitness field. The patient underwent posterior decompression, spinopelvic stabilization, and fusion. Postoperative rehabilitation was satisfactory and after six months, the leg muscle strength returned to normal and the patient's back pain disappeared. Conclusion KD should be considered as a rare differential diagnosis when dealing with any patient with a vertebral fracture associated with a history of minor trauma and an asymptomatic window period. A case of Kummell disease in a rare location (L5 vertebra) was reported. The usual consequence of this disease is a compression fracture in a neurologically intact patient. In our case, the creation of a burst fracture induced cauda equina syndrome. This case represents a rare cause of non-discogenic cauda equina syndrome. Our patient unlike most individuals with Kummell disease, due to significant neurologic deficit needed open surgery.
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Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis. FRONTIERS OF NURSING 2019. [DOI: 10.2478/fon-2019-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Objective
To compare the clinical efficacy between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of Kümmell’s disease in Chinese patients.
Methods
The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell’s disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM (from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell’s disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis.
Results
Through comparison, Cobb angle (95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index (ODI) (95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group (95% CI [−1.27, −0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group (95% CI [−13.48, −7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale (VAS) score (95% CI [−0.04, 0.27), P = 0.15), cement volume (95% CI [−0.82, 0.32], P = 0.39) and cement leakage (95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures.
Conclusions
At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell’s disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results (e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.
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van Gemert LN, Campbell PM, Opperman LA, Buschang PH. Localizing the osseous boundaries of micro-osteoperforations. Am J Orthod Dentofacial Orthop 2019; 155:779-790. [PMID: 31153498 DOI: 10.1016/j.ajodo.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim of this work was to determine how far the effects of micro-osteoperforations (MOPs) extend within bone by quantifying the damage caused and the short-term bony adaptations that occur in and around the injury site. METHODS With the use of a split-mouth design, 34 MOPs (Propel) were randomly placed in the mandibular furcal bone of 13 beagle dogs either 2 or 4 weeks before killing them. The control side received no treatment. Vickers hardness microindentation, microscopic computed tomography, and histologic analyses were performed to evaluate the bone surrounding the MOPs. RESULTS Microfractures produced during insertion extended ∼0.6 mm from the MOP sites. Cortical and trabecular bone were significantly less dense on the experimental than on the control side up to 4.2 mm from the edge of the MOP, but side differences were small (<5%) beyond 1.5 mm from the MOP. Experimental cortical bone was significantly softer than the control bone up to 0.8 mm from the MOP after 2 weeks of healing, and up to 0.5 mm from the MOP after 4 weeks of healing. Hematoxylin and eosin stained sections of cortical and trabecular bone showed small areas of woven bone within the MOP sites after 2 weeks, and acellular areas of bone extending ∼0.5 mm from the MOP. After 4 weeks of healing, there were greater amounts of woven bone, as well as early signs of lamellar bone, in and around the MOP sites. Markedly increased TRAP activity extending up to 2.5 mm from the MOP was evident after 2 weeks, but not after 4 weeks. Vital fluorescence staining showed diffuse bone deposition on the experimental side up to 1.5 mm from the MOP margin. CONCLUSIONS When MOPs are performed in beagle dogs, demineralization is transient and healing of the injured area, as well as remineralization of bone affected by MOP placement, begins during the first 2 weeks. Although the transient effects extend farther, the principal effects extend only ∼1.5 mm from the MOP site.
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Affiliation(s)
| | - Phillip M Campbell
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Tex
| | - Lynne A Opperman
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, Tex
| | - Peter H Buschang
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Tex.
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He D, Yu W, Chen Z, Li L, Zhu K, Fan S. Pathogenesis of the intravertebral vacuum of Kümmell's disease. Exp Ther Med 2016; 12:879-882. [PMID: 27446290 PMCID: PMC4950591 DOI: 10.3892/etm.2016.3369] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/19/2016] [Indexed: 12/20/2022] Open
Abstract
In this review, we explored the progress of the pathogenesis of Kümmell's disease intravertebral vacuum. Using different expressions of the same disease including 'Kümmell's disease', 'avascular necrosis after vertebral compression fracture (VCF)', 'post-traumatic vertebral osteonecrosis', 'vertebral pseudarthrosis', 'intravertebral vacuum (cleft or gas)', 'delayed vertebral collapse', 'VCF nonunion', and by conducting a search of the PubMed database, we analyzed the results to examine the pathogenesis of the intravertebral vacuum of Kümmell's disease after referring to pertinent literature on intravertebral vacuum of ischemic necrosis after VCF, and exploring the progress of pathogenesis of this disease. A number of discrepancies were identified within the pathogenesis of the intravertebral vacuum after VCF. There were statements such as avascular necrosis of the vertebral body, bone biomechanics, gas forming and other types of claims, all of which obtained clinical and biomechanical supporting evidence. Collectively, most of the researchers believe that Kümmell vertebral fracture syndrome was the comprehensive effect of multiple factors including osteoporosis, avascular necrosis of the vertebral body, and biomechanical changes following fracture. However, there are a number of discrepancies to be resolved and future studies are therefore needed.
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Affiliation(s)
- Dengwei He
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China; Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Weiyang Yu
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Zhenzhong Chen
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Liangchen Li
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Kejun Zhu
- Department of Orthopedics, Lishui Central Hospital, Wenzhou Medical University, Lishui, Zhejiang 323000, P.R. China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
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Kümmell’s disease: Is ischemic necrosis or vertebral “microcracking” the first step in the sequence? Med Hypotheses 2013; 80:505. [DOI: 10.1016/j.mehy.2012.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/02/2012] [Indexed: 11/22/2022]
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