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Another option to treat Kümmell’s disease with cord compression

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Abstract

The efficiency of short-segment fixation with transpedicle body augmenter (a titanium spacer with bone-ingrowth porous surface, TpBA) to treat Kümmell’s disease with cord compression (stage III) was retrospectively evaluated. No laminectomy or instrumentation reduction was done. Inclusion criteria included Frankel CDE, single-level within T10–L2. FU rate was 88%, i.e. 21 cases were included. Frankel function classification was 6E9D6C. Mean age was 72±8 years. F:M was 16:5. FU period was 48 M (range, 30–76 M). The hospitalization was 4.5±2.2 days; operation time, 70.4±17.2 min; blood loss, 150±72 cc. Final Frankel class was 20E1D. Complications included two superficial infection and one pneumonia. Body height and kyphosis were all corrected significantly and well preserved at the final visit. No TpBA dislodgement or implant failure was noted; however, three cases developed new compression fractures. The clinical outcome showed 81% with P1 or P2 by Denis pain scale. This method can decompress spinal canal, maintain kyphosis correction and vertebral restoration, prevent implant failure, and attain good clinical results.

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References

  1. Brower AC, Downey EF (1981) Kümmell disease: report of a case with serial radiographs. Radiology 141(2):363–364

    PubMed  CAS  Google Scholar 

  2. Van Eenenaam DP, el-Khoury GY (1993) Delayed post-traumatic vertebral collapse (Kümmell’s Disease): case report with serial radiographs, computed tomographic scans, and bone scans. Spine 18(9):1236–1241

    Article  PubMed  Google Scholar 

  3. Osterhouse MD, Kettner NW (2002) Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft. J Manipulative Physiol Ther 25(4):270–275

    Article  PubMed  Google Scholar 

  4. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 39(12):1410–1414

    Article  PubMed  CAS  Google Scholar 

  5. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. Am J Neuroradiol 18(10):1897–1904

    PubMed  CAS  Google Scholar 

  6. Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of Kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Spine 26(14):1631–1638

    Article  PubMed  CAS  Google Scholar 

  7. Li KC, Wong TU, Kung FC (2004) Staging of Kümmell’s disease. J Musculoskel Res 8:43–55

    Article  Google Scholar 

  8. Lehmer SM, Keppler L, Biscup RS, Enker P, Miller SD, Steffee AD (1994) Posterior transvertebral osteotomy for adult thoracolumbar kyphosis. Spine 19(18):2060–2067

    Article  PubMed  CAS  Google Scholar 

  9. Mochida J, Toh E, Chiba M, Nishimura K (2001) Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord 14(5):393–398

    Article  PubMed  CAS  Google Scholar 

  10. Kaneda K, Asano S, Hashimoto T, Satoh S, Fujiya M (1992) The treatment of osteoporotic post-traumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine 17(8 Suppl):S295–S303

    PubMed  CAS  Google Scholar 

  11. Nguyen HV, Ludwig S, Gelb D (2003) Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech 16(1):10–19

    PubMed  Google Scholar 

  12. Aebi M, Etter C, Kehl T, Thalgott J (1988) The internal skeletal fixation system: a new treatment of thoracolumbar fractures and other spinal disorders. Clin Orthop 227:30–43

    PubMed  CAS  Google Scholar 

  13. Kramer DL, Rodgers WB, Mansfield FL (1995) Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 9(6):499–506

    Article  PubMed  CAS  Google Scholar 

  14. Matsuyama Y, Goto M, Yoshihara H, Tsuji T, Sakai Y, Nakamura H et al (2004) Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech 17(4):291–296

    Article  PubMed  Google Scholar 

  15. Li KC, Hsieh CH, Lee CY, Chen TH (2005) Transpedicle body augmenter: a further step in treating burst fractures. Clin Orthop 436:119–125

    PubMed  Google Scholar 

  16. Chen HH, Wang WK, Li KC, Chen TH (2004) Biomechanical effects of the body augmenter for reconstruction of the vertebral body. Spine 29(18):E382–E387

    Article  PubMed  Google Scholar 

  17. Li KC, Chen HH, Li A, Hsieh CH (2004) Safe zone for application of transpedicle body augmenter. J Orthop Surg Taiwan 21:125–133

    CAS  Google Scholar 

  18. Rampersaud YR, Simon DA, Foley KT (2001) Accuracy requirements for image-guided spinal pedicle screw placement. Spine 26(4):352–359

    Article  PubMed  CAS  Google Scholar 

  19. Daniaux H, Seykora P, Genelin A, Lang T, Kathrein A (1991) Application of posterior plating and modifications in thoracolumbar spine injuries: indication, techniques and results. Spine 16(3 Suppl):S125–S133

    PubMed  CAS  Google Scholar 

  20. Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 26(1):61–65

    Article  PubMed  CAS  Google Scholar 

  21. Verlaan JJ, van de Kraats EB, van Walsum T, Dhert WJ, Oner FC, Niessen WJ (2005) Three-dimensional rotational X-ray imaging for spine surgery: a quantitative validation study comparing reconstructed images with corresponding anatomical sections. Spine 30(5):556–561

    Article  PubMed  Google Scholar 

  22. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia: Part I. Paraplegia 7(3):179–192

    PubMed  CAS  Google Scholar 

  23. Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit: a comparison between operative and nonoperative treatment. Clin Orthop 189:142–149

    PubMed  Google Scholar 

  24. Arciero R, Leung K, Pierce J (1989) Spontaneous unstable burst fracture of the thoracolumbar spine in osteoporosis: a report of two cases. Spine 14(1):114–117

    Article  PubMed  CAS  Google Scholar 

  25. Hasegawa K, Homma T, Uchiyama S, Takahashi HE (1997) Osteosynthesis without instrumentation for vertebral pseudarthrosis in osteoporotic spine. J Bone Joint Surg [Br] 79(3):452–456

    Article  CAS  Google Scholar 

  26. Heggeness MH (1993) Spine fracture with neurologic deficit in osteoporosis. Osteoporos Int 3(4):215–221

    Article  PubMed  CAS  Google Scholar 

  27. Kaplan PA, Orton DF, Asleson RJ (1987) Osteoporosis with vertebral compression fractures, retropulsed fragments and neurologic compromise. Radiology 165(2):533–535

    PubMed  CAS  Google Scholar 

  28. Kempinsky WH, Morgan PP, Boniface WR (1958) Osteoporotic kyphosis with paraplegia. Neurology 8(3):181–186

    PubMed  CAS  Google Scholar 

  29. Korovessis P, Maraziotis T, Piperos G, Spyropoulos P (1994) Spontaneous burst fracture of the thoracolumbar spine in osteoporosis associated with neurologic impairment: a report of seven cases and review of the literature. Eur Spine J 3(5):286–288

    Article  PubMed  CAS  Google Scholar 

  30. Lafforgue P, Daumen-Legre V, Schiano A, Peragut JC, Acquaviva PC (1990) Neurologic complications of osteoporotic vertebral compression: three new cases and critical analysis of the literature. Rev Rheum Mal Osteoartic 57(9):619–625

    CAS  Google Scholar 

  31. Maruo S, Tatekawa F, Nakano K (1987) Paraplegia caused by vertebral compression fractures in senile osteoporosis. Z Orthop Ihre Grenzgeb 125(3):320–323

    Article  PubMed  CAS  Google Scholar 

  32. Rhee JM, Hu SS, Beuff HU et al (1998) The results of spinal reconstructive surgery in the elderly (paper no. 16). Presented at the Scoliosis Research Society Meeting, St. Louis

  33. Salomon C, Chopin D, Benoist M (1988) Spinal cord compression: an exceptional complication of spinal osteoporosis. Spine 13(2):222–224

    Article  PubMed  CAS  Google Scholar 

  34. Tanaka S, Kubota M, Fujimoto Y, Hayashi J, Nishikawa K (1993) Conus medullaris syndrome secondary to an L1 burst fracture in osteoporosis. Spine 18(14):2131–2134

    Article  PubMed  CAS  Google Scholar 

  35. Yoo J, Hillebrand A, Bohlman HH (1998) Functional recovery following surgical treatment of osteopenic vertebral body fractures with resulting neurologic deficit in elderly patients (paper no. 39). Presented at the Scoliosis Research Society Meeting, St. Louis

  36. Baba H, Maezawa Y, Kamitani K, Furusawa N, Imura S, Tomita K (1995) Osteoporotic vertebral collapse with late neurological complications. Paraplegia 33(5):281–289

    PubMed  CAS  Google Scholar 

  37. Kim KT, Suk KS, Kim JM, Lee SH (2003) Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27(2):65–69

    PubMed  Google Scholar 

  38. Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J (1990) Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 15(6):485–489

    Article  PubMed  CAS  Google Scholar 

  39. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323

    Article  PubMed  CAS  Google Scholar 

  40. Fribourg D, Tang C, Sra P et al (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29:2270–2276

    Article  PubMed  Google Scholar 

  41. Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25(2):175–180

    PubMed  Google Scholar 

Download references

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Li, KC., Li, A.FY., Hsieh, CH. et al. Another option to treat Kümmell’s disease with cord compression. Eur Spine J 16, 1479–1487 (2007). https://doi.org/10.1007/s00586-006-0094-z

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  • DOI: https://doi.org/10.1007/s00586-006-0094-z

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