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

Hyung-Youl Park; Ki-Won Kim; Ji-Hyun Ryu; S Tim Yoon; In-Hwa Baek; Tae-Yang Jang; Jun-Seok Lee

doi:10.1177/21514593211027055

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

Geriatr Orthop Surg Rehabil. 2021 Jun 28:12:21514593211027055. doi: 10.1177/21514593211027055. eCollection 2021.

Authors

Hyung-Youl Park¹, Ki-Won Kim², Ji-Hyun Ryu², S Tim Yoon³, In-Hwa Baek¹, Tae-Yang Jang¹, Jun-Seok Lee¹

Affiliations

¹ Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Eunpyeong-gu, Seoul, Republic of Korea.
² Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Eunpyeong-gu, Seoul, Republic of Korea.
³ Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA.

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.

Keywords: neurologic manifestations; spinal fractures; spinal fusion; vertebroplasty.