Efficacy and safety of hollow pedicle screw-anchored bone cement combined with posterior long-segment fixation for Stage III Kümmell's disease

Abstract

Objectives: The study aimed to evaluate the efficacy and safety of hollow pedicle screw-anchored bone cement combined with posterior long-segment fixation (LSF) for the treatment of Stage III Kümmell's disease.

Patients and methods: The study retrospectively analyzed 23 patients (18 females, 5 males; mean age: 70.1±6.2 years; range, 58 to 80 years) with Stage III Kümmell's disease who underwent hollow pedicle screw-anchored bone cement combined with posterior LSF between March 2017 and April 2020. The clinical efficacy was evaluated using the Visual Analog scale (VAS), the Oswestry Disability Index (ODI), anterior vertebral height, kyphotic Cobb angle, and neurological function by Frankel classification. Complications, operation time, intraoperative blood loss, and complications were obtained from the hospital records. Data recorded at three time intervals (before the surgery, early postoperative period, and the last follow-up) were compared.

Results: The mean follow-up time was 20.8±6.1 months. The mean operation time was 102±16.5 min, and the mean intraoperative blood loss was 225±41.3 mL. The VAS, ODI, anterior vertebral heights, and local kyphosis angle showed statistically significant differences between preoperative and postoperative values, as well as the preoperative and the final follow-up values (p<0.05). However, the differences between postoperative and final follow-up values were not statistically significant (p>0.05). Six patients (26%) had mild preoperative neurological deficits and normalized neurological function at the final follow-up evaluation. Asymptomatic leakage of cement occurred in five (22%) cases. There was no fixation failure (rod breakage or screw loosening).

Conclusion: Hollow pedicle screw-anchored bone cement combined with posterior LSF is a safe and effective surgical option for the treatment of Stage III Kümmell's disease.

Figure 1. A 64-year-old female patient who underwent hollow pedicle screw-anchored bone cement combined with posterior LSF for L1 Kümmell’s disease. (a, b) Preoperative sagittal and coronal radiographs showing a severely collapsed vertebra and kyphotic deformity. (c, d) Preoperative sagittal and coronal CT scan demonstrating the intervertebral cleft and breakage of the posterior cortex in the L1 vertebra. (e, f) Preoperative T1-weighted magnetic resonance imaging showing a low signal of fluid and gas in the injured vertebra, spinal cord compression, and T2-weighted fat-suppression images showing a high signal. (g, h)Early postoperative radiographs demonstrating restoration of the vertebral height and the kyphosis. (i, j) Radiographs showing no significant loss of vertebral height, no recurrence of kyphosis, good positioning of the injured vertebral cement, and no loosening or fracture of the internal fixation at the last follow-up visit.: LSF: Long-segment fixation; CT: Computed tomography.

Figure 2. A 76-year-old female patient who underwent hollow pedicle screw-anchored bone cement combined with posterior LSF for T12 Kümmell’s disease. (a, b) Preoperative radiographs showing a severely collapsed T12 vertebra and kyphotic deformity. (c, d) Preoperative coronal and sagittal CT scans showing a wedge-shaped change in the T12 vertebral body with interruption of the bony structure and a translucent line shadow. (e, f) Preoperative T1-weighted magnetic resonance imaging demonstrating a low signal in the injured vertebra and spinal cord compression, and T2-weighted fat-suppression images showing a high signal. (g, h) Early postoperative radiographs. (i, j) Radiographs showing no significant loss of vertebral height, no recurrence of kyphosis, good positioning of the injured vertebral cement, and no loosening or fracture of the internal fixation at the last follow-up visit.: LSF: Long-segment fixation; CT: Computed tomography.