Research ArticleLumbar Spine

Minimally Invasive Surgery Transpedicular Intrabody Cage Technique for the Management of Kummell Disease

Junseok Bae, Chay-you Ang, Ifthekar Syed, Seong Kyun Jeong, Sang Ha Shin and Sang-Ho Lee
International Journal of Spine Surgery February 2024, 18 (1) 73-80; DOI: https://doi.org/10.14444/8570

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Initial magnetic resonance imaging (MRI) showing an acute T12 fracture (A). Initial lateral radiograph showing T12 fracture with superior endplate depression (B). Lateral radiograph after 4 months showing kyphotic deformity (C). MRI after 4 months showing intervertebral cleft sign (arrow) and kyphotic deformity (D). Computed tomography image after 4 months showing intervertebral cleft (arrow) and nonunion of T12 fracture (E).

  • Figure 2
    Figure 2

    Intraoperative lateral radiograph after insertion of Jamshidi needles (A). Insertion of the METRx dilator through one of the pedicles at the fractured vertebrae. (B). Insertion of cage trial into the fractured vertebrae to restore the vertebral height (C). Postinsertion of crescent cage (Medtronic) demonstrates satisfactory vertebral height restoration (D).

  • Figure 3
    Figure 3

    Immediate postoperative radiograph demonstrating correction of the kyphosis (A). Lateral radiograph at 12 months postoperation (B).The computed tomography at 12 months postsurgery demonstrating the union of the fracture (C). Radiograph immediately postremoval of implants (D). One year postremoval of implants (E).

  • Figure 4
    Figure 4

    A tubular retractor is placed after serial dilatations via the guidewire (A). Serial cage trials were introduced into the anterior column of the vertebral body to restore the vertebral body height (B).

  • Figure 5
    Figure 5

    A banana-shaped polyetheretherketone cage filled with demineralized bone matrix and allograft was placed into the verterbae, restoring the height of the vertebral body.

  • Figure 6
    Figure 6

    Progressive dilatation was first performed using sequential trials (A). The cage was inserted obliquely into the vertebral body using a cage holder (B). Using a ball-tipped tamp, the cage was rotated into place through the gentle use of the mallet (C). The position of the cage was ascertained under fluoroscopy, and an anterior pusher can be used to push the cage anteriorly if necessary (D).

  • Figure 7
    Figure 7

    A percutaneous pedicle screw was inserted into each pedicle at the cranial and caudal vertebrae. A short pedicle screw was inserted into the contralateral pedicle at the index level for further stabilization.

Tables

  • Table 1

    Demographic data of patients.

    Demographics N = 20
    Age, y, mean ± SD73.1 ± 6.1
    Sex, M/F, n 10/10
    History of trauma (mo before surgery), mean ± SD5.1 ± 3.9
    Follow-up, mo, mean ± SD18.4 ± 5.1
    Bone mineral density, mean ± SD−3.0 ± 1.2
    Level of surgery, n (%)
     T111 (5%)
     T126 (30%)
     L18 (40%)
     L24 (20%)
     L31 (5%)
    Operation time, min, mean ± SD118 ± 36.2
    Estimated blood loss, mL, mean ± SD216 ± 66.8
  • Table 2

    Radiological data.

    DataPreoperativePostoperative P a 12-mo Follow-up P a
    Segmental angle, °15.2 ± 8.71.2 ± 5.2<0.013.6 ± 6.7<0.01
    Anterior body height, mm13.3 ± 14.622.6 ± 12.2<0.0121.9 ± 12.6<0.01
    Mean vertebral body height, mm18.5 ± 6.825.6 ± 7.6<0.0123.6 ± 4.4<0.01

    • ↵a P value in comparison with preoperative state.

  • Table 3

    Visual analog scale and Oswestry Disability Index scores.

    Outcome MeasurePreoperative12-mo Follow-up P
    Visual analog scale8.0 ± 0.92.3 ± 0.5<0.01
    Oswestry disability index43 ± 13.822.9 ± 15.2<0.05
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Minimally Invasive Surgery Transpedicular Intrabody Cage Technique for the Management of Kummell Disease
Junseok Bae, Chay-you Ang, Ifthekar Syed, Seong Kyun Jeong, Sang Ha Shin, Sang-Ho Lee
International Journal of Spine Surgery Feb 2024, 18 (1) 73-80; DOI: 10.14444/8570
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