Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell's Disease With Neurologic Deficits-A Retrospective Case Series

• Type of Material: Article
• Authors: Hyung-Youl Park, Catholic University of Korea; Ki-Won Kim, Catholic University of Korea; Ji-Hyun Ryu, Catholic University of Korea; Tim S Yoon, Emory University; In-Hwa Baek, Catholic University of Korea; Tae-Yang Jang, Catholic University of Korea; Jun-Seok Lee, Catholic University of Korea
• Language: English
• Date: 2021-06-25
• Publisher: SAGE PUBLICATIONS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/21514593211027055
• Title of Journal or Parent Work: GERIATRIC ORTHOPAEDIC SURGERY & REHABILITATION
• Volume: 12
• Start Page: 21514593211027055
• End Page: 21514593211027055
• Grant/Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a Small Grant for Exploratory Research (SGER) through the Ministry of Education of the Republic of Korea and The Catholic University of Korea Songeui (2018R1D1A1A02049202).
• Keywords: spinal fusion; SURGERY; COMPLICATIONS; vertebroplasty; BONE-CEMENT; Rehabilitation; Life Sciences & Biomedicine; neurologic manifestations; Surgery; AUGMENTATION; VERTEBRAL COLLAPSE; Geriatrics & Gerontology; DECOMPRESSION; Orthopedics; OSTEOPOROTIC SPINE; INSTRUMENTATION; Science & Technology; spinal fractures; PEDICLE SCREW FIXATION; OSTEOTOMY
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Purpose: Various surgical methods have been reported for Kummell’s disease with neurologic deficits. The aim of this study was to introduce long-segmental posterior fusion (LPF) combined with vertebroplasty (VP) and wiring as an alternative surgical technique. Material and Methods: We retrospectively analyzed 10 patients undergoing posterior decompression and LPF combined with VP and wiring for Kummell’s disease with neurologic deficits from January 2011 to December 2014. The radiologic outcomes included the local kyphotic angle (LKA) and segmental kyphotic angle (SKA). Clinical outcomes, including the visual analog scale (VAS), the Oswestry Disability Index (ODI) and the Frankel grade were assessed. Surgery-related complications were also evaluated. Results: The mean age of the included patients was 77 ± 8 years with a mean follow-up period of 31.4 ± 4.9 months and a mean bone mineral density of −3.5 ± 0.7 (T-score). The mean operation time was 220 ± 32.3 minutes with a mean blood loss of 555 ± 125.7 mL. The preoperative LKA and SKA were significantly corrected postoperatively (37.9 ± 8.7° vs. 15.3 ± 5.3°, p = 0.005 for LKA; 21.3 ± 5.1° vs. 7.6 ± 2.8°, p = 0.005 for SKA) without a loss of correction at the last follow-up. The VAS and ODI were also significantly improved (7.7 ± 1.1 vs. 3.0 ± 1.6, p = 0.007 for VAS; 90.3 ± 8.9 vs. 49.6 ± 22.7, p = 0.007 for ODI). The Frankel grade of all patients was improved by at least 1 or 2 grades at the last follow-up. Surgery-related complications such as intraoperative cement leakage and implant loosening during the follow-up were not observed. Conclusions: LPF combined with VP and wiring might be an effective surgical option for Kummell’s disease with neurologic deficits, especially for the elderly patients with morbidities. Level of Evidence: level IV.