Percutaneous kyphoplasty versus posterior spinal fixation with vertebroplasty for treatment of Kümmell disease

This is a retrospective case-control study.The aim of this study was to compare the surgical results of percutaneous kyphoplasty (KP) and posterior spinal fixation with vertebroplasty (PSF+VP) for treatment of Kümmell disease (KD).KD is rare form of post-traumatic delayed avascular necrosis of the vertebral body. It is reported that KP is an effect measure for treatment of KD. Some studies have recommended posterior spinal fixation with vertebroplasty for KD.A total of 100 patients with KD who underwent spinal surgery at our hospital were enrolled from January 2008 to December 2013. The inclusion criteria were monosegment lesion without neurological deficit; the segments are restricted to T11-L2; conservative treatment is invalid. The exclusion criteria were metastatic spinal tumors, infection, primary bone tumor, and multiple myeloma; bisegments and multi-segments; patients with neurological symptoms; the defect of posterior wall of vertebral body; the occupying of vertebral canal. The symptomatic vertebrae were restricted to T11-L2. Patients who were followed-up for less than 2 years after surgery were excluded. Finally, there are 25 patients in the KP group and 21 in the PSF+VP group. There were no significant differences in patient age, disease duration, or the length of follow-up between the 2 groups.Operative time (43.2 ± 21.8 vs 230.6 ± 87.1 minutes) was significantly longer and bleeding volume (5.3 ± 3.1 vs 215.0 ± 170.2 mL) significantly greater in the PSF+VP group. No significant difference between the 2 groups was observed in Visual analog scale score (VAS) (1.3 ± 0.9 vs 1.2 ± 0.9), Oswestry disability index score (ODI) (27.2 ± 9.0 vs 26.0 ± 6.3), and Cobb angle (17.0 ± 7.2 vs 16.5 ± 2.8). KP resulted in a shorter operation time, less bleeding volume, and fewer postoperative complications than PSF+VP.This study shows that both treatments KP and PSF+VP for KD can be safe and effective for the patients with monosegment lesion and without neurological deficit. However, KP show the advantages in a shorter surgical duration, less blood loss, and fewer postoperative complications.