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Song KS, Yoon BI, Ham DW. Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series. World Neurosurg 2024; 184:119-124. [PMID: 38266993 DOI: 10.1016/j.wneu.2024.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. METHODS Six consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle, restoration ratio of anterior vertebral height of the index vertebra, and clinical outcomes including the Oswestry Disability Index, EuroQol 5-dimension instrument, and visual analog scale for back and leg pain, were compared between the preoperative and final follow-ups. RESULTS All patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative restoration ratio of anterior vertebral height was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative local kyphosis angle was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. CONCLUSIONS Expandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's end plates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
| | - Byung-Il Yoon
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Zhang JQ, Zeng ZY, Lu HG, Yu W, Hu XQ, Chen WS, Chen G. A comparative study of PSPVP and PSIBG in the treatment of stage II–III Kummell’s disease. Biomed Mater Eng 2022; 34:261-276. [DOI: 10.3233/bme-221456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) are commonly employed for Kummell’s disease in stages II–III; however, these techniques produce some complications. OBJECTIVE: To compare the clinical efficacy and imaging results of percutaneous vertebroplasty + bone cement-augmented short-segment pedicle screw fixation (PSPVP) versus transpedicular intracorporeal bone grafting + pedicle screw fixation (PSIBG) in the treatment of stage II–III Kummell’s disease. METHODS: A total of 69 patients admitted between November 2017 and March 2021 were included in this study; 36 of these were treated with PSPVP, and 33 were treated with PSIBG. Patients in the two groups were compared in terms of perioperative, follow-up, and imaging data. RESULTS: No statistically significant differences were found between the two groups in terms of operation duration (P > 0.05). However, the PSPVP group was superior to the PSIBG group in terms of incision length, intraoperative blood loss, and length of stay (P < 0.05). All patients were followed up for more than 12 months. The VAS score, height of anterior vertebral margin, kyphosis Cobb angle, wedge angle of the affected vertebra at seven days after surgery and last follow-up, and the ODI index at the last follow-up of the two groups were significantly improved compared with figures before surgery (P < 0.05). Compared with values before surgery, no statistically significant differences were found in the height of the posterior vertebral margin in the PSPVP group at seven days after surgery and at the last follow-up (P > 0.05). There were also no statistically significant differences in the VAS score, ODI index, kyphosis Cobb angle, and wedge angle of the affected vertebra between the two groups at corresponding time points (P > 0.05). The heights of the anterior and posterior vertebral margins in the PSIBG group were better than those in the PSPVP group after surgery and at the last follow-up (P < 0.05). In the PSPVP group, a pedicle screw fracture occurred in one patient two months after surgery, while an upper adjacent vertebral fracture occurred in one patient eight months after surgery. CONCLUSION: Both PSPVP and PSIBG can achieve good early clinical efficacy in the treatment of stage II–III Kummell’s disease, with PSPVP being relatively less invasive while producing a poorer orthopedic effect and more complications than PSIBG.
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Affiliation(s)
- Jian-Qiao Zhang
- , The Second Affiliated Hospital of Jiaxing University, , China
| | - Zhong-You Zeng
- , Hospital of Coast Guard General Corps of Armed Police Forces, , China
| | - Hui-Gen Lu
- , The Second Affiliated Hospital of Jiaxing University, , China
- , The Second Affiliated Hospital Zhejiang University School of Medicine, , China
| | - Wei Yu
- , Hospital of Coast Guard General Corps of Armed Police Forces, , China
| | - Xu-Qi Hu
- , The Second Affiliated Hospital of Jiaxing University, , China
| | - Wei-Shan Chen
- , The Second Affiliated Hospital Zhejiang University School of Medicine, , China
| | - Gang Chen
- , The Second Affiliated Hospital of Jiaxing University, , China
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Comparison between Percutaneous Kyphoplasty and Posterior Fixation Combined with Vertebroplasty in the Treatment of Stage III Kümmell’s Disease without Neurological Deficit. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2193895. [PMID: 36119933 PMCID: PMC9477635 DOI: 10.1155/2022/2193895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022]
Abstract
Objective. To evaluate the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) versus posterior fixation combined with vertebroplasty PF+VP for treating stage III Kümmell’s disease (KD) patients without neurological deficits. Methods. From April 2016 to February 2020, a total of 88 patients with single-level stage III KD without neurological deficits, including 45 patients treated by PKP and 43 patients who underwent posterior fixation combined with vertebroplasty PF+VP, were retrospectively studied. The outcome parameters, including blood loss, operative time, kyphotic Cobb angle, height of vertebrae, Oswestry Disability Index (ODI), and visual analog scale (VAS) score, were compared between the PKP group and the PF+VP group. Results. The mean follow-up time was
months, ranging from 24 to 48 months. The kyphotic angle and vertebral height in both groups were significantly improved compared with those before surgery at three days, 3 months and the final follow-up. The estimated blood loss, operative time, and length of stay were significantly lower in the PKP group than in the PF+VP group (
). The FP+VP group showed better results in kyphotic angle correction than the PKP group (
). In the short-term follow-up (up to 3 months), the PKP group had lower VAS and ODI scores than the PF+VP group. In contrast, there were no significant differences between the two groups (
) at the final follow-up. The average cost of PKP was lower than that of PF+VP. Conclusion. The results of our study showed that both PKP and PF+VP were safe and effective for stage III KD patients without neurological deficits. Although PF+VP presents better performance in kyphotic angle correction, PKP was associated with less surgical trauma, quicker pain relief, and lower expense than PF+VP. Therefore, it can be considered an alternative option for patients with advanced KD.
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Li H, Tang Y, Liu Z, Yang H, Zhang Z, Zhang K, Chen K. The comparison of percutaneous kyphoplasty and vertebroplasty for the management of stage III Kummell disease without neurological symptoms. BMC Surg 2022; 22:319. [PMID: 35987609 PMCID: PMC9392278 DOI: 10.1186/s12893-022-01770-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To compare the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) in the treatment of stage III Kummell disease without neurological deficit.
Methods
This retrospective study involved 41 patients with stage III Kummell disease without neurological deficit who underwent PKP or PVP from January 2018 to December 2019. Demographic data and clinical characteristics were comparable between these two groups before surgery. Operation time, volume of injected bone cement, intraoperative blood loss and time of hospital stay were analyzed. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) scoring were assessed for each patient before and after operation. Radiographic follow-up was assessed by the height of anterior (Ha), the height of middle (Hm), Cobb’s angle, and Vertebral wedge ratio (VWR). The preoperative and postoperative recovery values of these data were used for comparison.
Results
The two groups showed no significant difference in demographic features (p > 0.05). What’s more, the operation time, intraoperative blood loss, and time of hospital stay revealed no sharp statistical distinctions either (p > 0.05), except PKP used more bone cement than PVP (7.4 ± 1.7 mL vs 4.7 ± 1.4 mL, p < 0.05). Radiographic data, such as the Ha improvement ratio (35.1 ± 10.2% vs 16.2 ± 9.4%), the Hm improvement ratio (41.8 ± 11.3% vs 22.4 ± 9.0%), the Cobb’s angle improvement (10.0 ± 4.3° vs 3.5 ± 2.1°) and the VWR improvement ratio (30.0 ± 10.6% vs 12.7 ± 12.0%), were all better in PKP group than that in PVP group (p < 0.05). There were no statistical differences in the improvement of VAS and ODI 1-day after the surgery between these two groups (p > 0.05). However, at the final follow-up, VAS and ODI in PKP group were better than that in PVP (p < 0.05). Cement leakage, one of the most common complications, was less common in the PKP group than that in the PVP group (14.3% vs 45.0%, p < 0.05). And there was 1 case of adjacent vertebral fractures in both PKP and PVP (4.8% vs 5.0%, p > 0.05), which showed no statistical difference, and there were no severe complications recorded.
Conclusions
For stage III Kummell disease, both PKP and PVP can relieve pain effectively. Moreover, PKP can obtain more satisfactory reduction effects and less cement leakage than PVP. We suggested that PKP was more suitable for stage III Kummell disease without neurological deficit compared to PVP from a vertebral reduction point of view.
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Pan D, Chen D. Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease. Geriatr Orthop Surg Rehabil 2022; 13:21514593221099264. [PMID: 35557599 PMCID: PMC9087232 DOI: 10.1177/21514593221099264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the clinical efficacy of unipedicular and bipedicular percutaneous kyphoplasty (PKP) for Kummell's disease. Methods A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21). Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated. Results All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < .05), and local kyphotic angle and average vertebral height were restored markedly (P < .05). Operative time of both groups had no significant difference (P > .05). Bone cement injection volume was larger in bipedicular group (P < .05). At 1 day after operation and the last follow-up, the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < .05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > .05). Conclusion Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.
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Affiliation(s)
- Dan Pan
- Department of Spinal Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Dayong Chen
- Department of Spinal Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
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Morimoto T, Kobayashi T, Yoshihara T, Tsukamoto M, Kai K, Mawatari M. Fatal fat embolism syndrome during posterior spinal fusion surgery: A case report and literature review. Medicine (Baltimore) 2021; 100:e28381. [PMID: 34941165 PMCID: PMC8702169 DOI: 10.1097/md.0000000000028381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Fat embolism syndrome (FES) is a rare but potentially lethal complication. Although serious FES is associated with long bone fractures and major joint surgery, the number of patients who develop fatal FES intraoperatively is probably higher than the described number. We herein report an extremely rare autopsy-confirmed case of fatal FES during posterior spinal fusion to enhance pedicle screw (PS) fixation with allograft bone augmentation. PATIENT CONCERNS A 74-year-old woman came to the hospital complaining of back pain, lower extremity pain and numbness, and intermittent claudication. DIAGNOSIS She was diagnosed with lumbar degenerative scoliosis and lumbar spinal canal stenosis based on imaging findings. INTERVENTIONS During posterior spinal fusion to enhance pedicle screw fixation with allograft bone augmentation, her blood pressure and oxygen saturation dropped significantly, so the operation was stopped, and cardiopulmonary resuscitation was performed. Chest computed tomography demonstrated bilateral diffuse alveolar infiltrates. OUTCOMES The patient died three days later due to fat embolism. The autopsy revealed diffuse myocardial ischemia and diffuse alveolar damage. Numerous fat emboli were observed at lung, kidney and spleen and small necrotic bone fragments, possibly derived from allograft bone debris, were found in the peripheral pulmonary artery. LESSONS Fatal FES associated to seemingly harmless isolated osteoporotic vertebral fractures-vertebroplasty and posterior spinal fusion has been reported. The mechanism was hypothesized to be that both vertebral fractures and spine surgery have the potential to involve bone marrow, thereby increasing intraosseous pressure, and this pressure dislodges fat and bone marrow and pushes them out into the venous circulation, causing systemic inflammation.This is the first report to show histological evidence that the allografted bone embolized to the lungs. Although several reports have indicated that inserting reinforcing materials into the tapped screw holes can enhance the pedicle screw fixation, this procedure may cause severe FES due to fat and debris of material augmentation (i.e. cement, hydroxyapatite, allograft bone). It is important for physicians, especially spinal surgeons, and anesthetists, to be aware of the potential for FES to occur during spinal surgery, which can cause serious complications in a small minority of patients.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Keita Kai
- Department of pathology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
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Therapeutic Efficacy of Transpedicular Impaction Bone Grafting with Long Segmental Posterior Instrumentation in Stage III Kümmell Disease. Spine (Phila Pa 1976) 2021; 46:907-914. [PMID: 34100844 DOI: 10.1097/brs.0000000000003995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of clinical and radiological parameters. OBJECTIVE To evaluate the therapeutic efficacy of transpedicular impaction bone grafting (TIBG) with long segmental posterior instrumentation for the treatment of stage III Kümmell disease. SUMMARY OF BACKGROUND DATA The optimal treatment for stage III Kümmell disease remains controversial and unclear. Theoretically, transpedicular bone grafting can reconstruct anterior column support and reduce the failure of internal fixation, which is an intuitive method for the treatment of Kümmell disease. However, the use of this technique has rarely been reported for the treatment of this disease. This study reported the clinical and radiological results of TIBG with long segmental posterior instrumentation for the treatment of stage III Kümmell disease. METHODS Between August 2011 and December 2017, we retrospectively analyzed 24 patients with stage III Kümmell disease who underwent TIBG with long segmental posterior instrumentation. Anterior vertebral heights, kyphotic Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) impairment scale were used to evaluate the effects of surgery. RESULTS The mean time to follow-up was 38.1 ± 10.2 months. The average operative duration was 136 ± 16.5 minutes, and the average intraoperative blood loss was 293 ± 41.3 mL. The VAS, ODI, anterior vertebral heights, and kyphotic Cobb angles were improved significantly at 1 week after surgery compared the preoperative examinations, and were well maintained at the final follow-up evaluation. Fourteen patients (58%) had mild neurological impairments before surgery, with neurological function returning to normal at the final follow-up evaluation. There was no instance of instrumentation failure. CONCLUSION TIBG combined with long segmental posterior instrumentation is a safe and effective surgical option for stage III Kümmell disease.Level of Evidence: 4.
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Lee J, Song KS. Transpedicular Intravertebral Cage Augmentation in a Patient with Neurologic Deficits After Severely Collapsed Kummel Disease: Minimum 2-Year Follow-Up. World Neurosurg 2020; 135:146-155. [DOI: 10.1016/j.wneu.2019.11.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
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Deng H, Li Y, Zhou J, Wang X, Du J, Gao W, Hao D. Therapeutic efficacy of Transpedicular Intracorporeal cement augmentation with short segmental posterior instrumentation in treating osteonecrosis of the vertebral body: a retrospective case series with a minimum 5-year follow-up. BMC Musculoskelet Disord 2019; 20:305. [PMID: 31253156 PMCID: PMC6599253 DOI: 10.1186/s12891-019-2671-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 06/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. Methods Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. Results A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. Conclusion The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.
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Affiliation(s)
- Hongli Deng
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jinsong Zhou
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaodong Wang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jinpeng Du
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wenjie Gao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
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Chen H, Yang J, Hao D. [Effectiveness of posterior short-segmental fixation with bone cement augmentation for stage Ⅲ Kümmell's disease with spinal canal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:707-711. [PMID: 31197997 DOI: 10.7507/1002-1892.201902001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of posterior short-segmental fixation with bone cement augmentation in treatment of stage Ⅲ Kümmell's disease with spinal canal stenosis. Methods Between June 2012 and January 2017, 36 patients with stage Ⅲ Kümmell's disease and spinal canal stenosis were treated by posterior short-segmental fixation and bone cement augmentation. There were 12 males and 24 females, aged 55-83 years (mean, 73.5 years). The disease duration ranged from 2 to 8 months, with an average of 4.6 months. Preoperative bone mineral density examination showed that all patients had different degrees of osteoporosis in the spines. The lesion segments included T 10 in 4 cases, T 11 in 7 cases, T 12 in 8 cases, L 1 in 9 cases, and L 2 in 8 cases. The preoperative neural function was classified as grade B in 4 cases, grade C in 12 cases, grade D in 13 cases, and grade E in 7 cases according to Frankle classification. The operation time, intraoperative blood loss, and the volume of injected bone cement, and hospital stay were recorded. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), kyphotic Cobb angle, and the height of anterior edge of injured vertebra were recorded before operation, at 1 week after operation, and at last follow-up; and the leakage of bone cement was observed. Results All operations were completed successfully. The operation time was 90-145 minutes (mean, 110.6 minutes); the intraoperative blood loss was 198-302 mL (mean, 242.5 mL); the volume of injected bone cement was 8.3-10.5 mL (mean, 9.2 mL); the hospital stays were 7-12 days (mean, 8.3 days). All patients were followed up 12-26 months (mean, 24.5 months). At 1 week after operation, the neural function was classified as grade B in 2 cases, grade C in 8 cases, grade D in 12 cases, and grade E in 14 cases, which was significantly improved when compared with that before operation ( Z=2.000, P=0.047). The VAS score, ODI, the height of anterior edge of injured vertebra, and Cobb angle were significantly improved at 1 week and last follow-up when compared with preoperative values ( P<0.05); but there was no significant difference between 1 week and last follow-up ( P>0.05). Two cases had asymptomatic cement leakage to the intervertebral disc at 1 week after operation; and 1 case had adjacent vertebral fracture at 8 months after operation. No complication such as loosening or breaking of internal fixator occurred during the follow-up. Conclusion Posterior short-segmental fixation with bone cement augmentation is a safe and effective surgical scheme for stage Ⅲ Kümmell's disease combined with spinal canal stenosis, which can avoid the aggravation of nerve injury and complications related to staying in bed.
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Affiliation(s)
- Hao Chen
- Xi'an Medical University, Xi'an Shaanxi, 710021, P.R.China;Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junsong Yang
- Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
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Huang YS, Hao DJ, Wang XD, Sun HH, Du JP, Yang JS, Gao J, Xue P. Long-Segment or Bone Cement–Augmented Short-Segment Fixation for Kummell Disease with Neurologic Deficits? A Comparative Cohort Study. World Neurosurg 2018; 116:e1079-e1086. [DOI: 10.1016/j.wneu.2018.05.171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Xiao-Dong Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hong-Hui Sun
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jin-Peng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jie Gao
- Graduate School of Xi'an Medical University, Xi'an, China
| | - Peng Xue
- Graduate School of Xi'an Medical University, Xi'an, China
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What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature. Asian Spine J 2018; 12:586-599. [PMID: 29879789 PMCID: PMC6002160 DOI: 10.4184/asj.2018.12.3.586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.
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Huang YS, Hao DJ, Feng H, Zhang HP, He SM, Ge CY, Niu XB. Comparison of Percutaneous Kyphoplasty and Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Management of Kümmell Disease. Med Sci Monit 2018; 24:1072-1079. [PMID: 29463783 PMCID: PMC5829537 DOI: 10.12659/msm.905875] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the efficacy of percutaneous kyphoplasty (PKP) and bone cement-augmented short segmental fixation (BCA+SSF) for treating Kümmell disease. MATERIAL AND METHODS Between June 2013 and December 2015, 60 patients were treated with PKP or BCA+SSF. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including Oswestry Disability Index (ODI), visual analogue scale (VAS), and kyphotic Cobb angle. RESULTS VAS, ODI, and Cobb angle, measured postoperatively and at the final follow-up, were lower than those measured preoperatively in both groups (P<0.05). VAS, ODI, and Cobb angle measured postoperatively demonstrated no significant differences when compared with those measured at the final follow-up in the PKP group (P>0.05). In the BCA+SSF group, VAS and ODI at the final follow-up were lower than those measured postoperatively (P<0.05), but no significant difference was found in the Cobb angle (P>0.05). The PKP group had better VAS and ODI than the BCA+SSF group, postoperatively (P<0.05). No significant difference was found in VAS and ODI at the final follow-up (P>0.05) or the Cobb angle measured postoperatively and at the final follow-up (P>0.05) between the 2 groups. Operative time, blood loss, and hospital stay in the PKP group were lower than those in the BCA+SSF group (P<0.05). No significant difference was found in complications (P>0.05). CONCLUSIONS PKP patients had better early clinical outcomes, shorter operation times and hospital admission times, and decreased blood loss, but had similar complications, radiographic results, and long-term clinical outcomes compared with BCA+SSF patients.
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Affiliation(s)
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hai-Ping Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Si-Min He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xing-Bang Niu
- Xi'an Medical Uniyersity, Xi'an, Shaanxi, China (mainland)
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Huang YS, Ge CY, Feng H, Zhang HP, Niu XB, Shi SY, Zhu ZQ, Hao DJ. Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis. Med Sci Monit 2018; 24:928-935. [PMID: 29443957 PMCID: PMC5820999 DOI: 10.12659/msm.905804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background This study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease. Material/Methods From June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification. Results The VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient. Conclusions Bone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.
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Affiliation(s)
| | - Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hai-Ping Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xing-Bang Niu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Shao-Yan Shi
- Xi'an Medical Uniyersity, Xi'an, Shaanxi, China (mainland)
| | - Zi-Qi Zhu
- Xi'an Medical Uniyersity, Xi'an, Shaanxi, China (mainland)
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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