Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Yuliang ,  XIONG Xiaoming , WAN Dun , DENG Xuangeng , SHI Huagang , SONG Simao , WU Xiao , ZHOU Jie , YANG Maoyi

Department of Spine Surgery, Sichuan Province Orthopedics Hospital, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

XIONG Xiaoming, Email: 2841710476@qq.com

Keywords：

Percutaneous kyphoplasty; Kümmell disease; osteoporosis; unilateral puncture; bilateral puncture

DOI：

10.7507/1002-1892.201704055

Video：

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Objective To compare the effectiveness between unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease. Methods The clinical data of 45 patients with Kümmell disease that met the criteria between January 2014 and February 2016 were analyzed retrospectively. Among them, 26 cases were treated by unilateral PKP (unilateral group), 19 cases were treated by bilateral PKP (bilateral group). There was no significant difference in gender, age, disease duration, injured vertebral segment, bone mineral density (T value), and the preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height, and kyphosis Cobb angle between 2 groups (P>0.05). The operation time, intraoperative fluoroscopy times, amount of injected bone cement, and hospitalization time were recorded, and the situation of bone cement leakage was observed. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle were evaluated before operation, at 1 day after operation, and at last follow-up. Results Bone cement leakage during the operation were found in 4 cases (15.38%) of unilateral group and 3 cases (15.79%) of bilateral group without obvious neurological symptoms; there was no significant difference in the incidence of bone cement leakage between 2 groups (χ²=0.000, P=1.000). The operation time, intraoperative fluoroscopy times, and amount of injected bone cement in the unilateral group were significantly lower than those in the bilateral group (P<0.05); but there was no significant difference in the hospitalization time between 2 groups (P>0.05). The X-ray film examination showed that there was no pulmonary embolism in all patients at 1 day after operation. All the patients were followed up 12-24 months, with an average of 16.4 months. There was no complication such as vertebral re-fracture or cement block displacement in the injured vertebra. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle at 1 day after operation and at last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05); the VAS score and ODI in 2 groups were further reduced at last follow-up when compared with the value at 1 day after operation (P<0.05), but the anterior vertebral height and kyphosis Cobb angle in 2 groups at last follow-up did not change significantly (P>0.05). There was no significant difference in above indexes at 1 day after operation and at last follow-up between 2 groups (P>0.05). Conclusion Both unilateral and bilateral PKP can achieve good effectiveness in treatment of Kümmell disease. But the unilateral puncture technique possesses advantages such as shorter operation time, less radiation dose, and less amount of injected bone cement.

Citation： SUN Yuliang, XIONG Xiaoming, WAN Dun, DENG Xuangeng, SHI Huagang, SONG Simao, WU Xiao, ZHOU Jie, YANG Maoyi. Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1086-1091. doi: 10.7507/1002-1892.201704055 Copy

1.	Freedman BA, Heller JG. Kummell disease: A not-so-rare complication of osteoporotic vertebral compression fractures. J Am Board Fam Med, 2009, 22(1): 75-78.
2.	Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
3.	王根林, 楊惠林, 孟斌, 等. 椎體后凸成形術治療骨質疏松性 Kümmell’s 病. 中國脊柱脊髓雜志, 2011, 21(1): 46-49.
4.	楊根林, 楊惠林, 姜為民, 等. 球囊擴張椎體后凸成形術治療骨質疏松性椎體骨折后骨壞死. 中華外科雜志, 2010, 48(8): 593-596.
5.	李厚坤, 王曉東, 楊小衛, 等. 單側椎弓根入路與雙側椎弓根入路 PKP 治療 Kummell’s 病的臨床對比研究. 中國矯形外科雜志, 2016, 24(18): 1660-1665.
6.	Kim KT, Suk KS, Kim JM, et al. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop, 2003, 27(2): 65-69.
7.	邱貴興, 裴福興, 胡偵明, 等. 中國骨質疏松性骨折診療指南 (骨質疏松性骨折診斷及治療原則). 中華骨與關節外科雜志, 2015, 8(5): 371-374.
8.	劉洋, 李明輝, 梅紅軍. 經皮椎體后凸成形術后骨水泥滲漏的回顧性分析及預防策略. 中國骨質疏松雜志, 2013, 19(4): 375-380.
9.	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
10.	Pflugmacher R, Kandziora F, Schroeder RJ, et al. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol, 2006, 47(4): 369-376.
11.	Phillips FM, Ho E, Campbell Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vetebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
12.	Wang G, Yang H, Meng B, et al. Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kypboplasty. J Clinic Neuros, 2011, 18(5): 664-668.
13.	張磊磊, 李健, 賈驚宇, 等. Kummell 病的研究進展. 中國矯形外科雜志, 2015, 23(9): 816-819.
14.	Luo J, Daines L, Charalambous A, et al. Vertebroplasty only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976), 2009, 34(26): 2865-2873.
15.	Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol, 2009, 30(10): 1835-1839.
16.	賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
17.	Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa1976), 2005, 30(2): 201-205.
18.	印飛, 孫振中, 宋升, 等. 單雙側經皮椎體后凸成形術治療中位胸椎骨質疏松性壓縮骨折對比研究. 中國修復重建外科雜志, 2016, 30(1): 77-81.
19.	郭金庫, 丁文元, 申勇, 等. 球囊擴張后凸椎體成形術治療老年骨質疏松性胸腰椎爆裂骨折. 中國修復重建外科雜志, 2010, 24(11): 1341-1344.
20.	姚女兆, 夏曦, 唐紹鋒. 序貫椎體成形術治療 Kummell 病的療效觀察. 中國修復重建外科雜志, 2015, 29(10): 1265-1268.
21.	Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J, 2014, 14(8): 1551-1558.
22.	徐松, 納強, 張雄文, 等. 分步筑墻 PKP 治療胸腰椎骨質疏松性骨折骨不連. 中國骨與關節損傷雜志, 2016, 31(3): 231-234.

1. Freedman BA, Heller JG. Kummell disease: A not-so-rare complication of osteoporotic vertebral compression fractures. J Am Board Fam Med, 2009, 22(1): 75-78.
2. Li KC, Kwon TU, Kung FC, et al. Staging of Kümmell’s disease. Musculoskeletal Res, 2004, 8(2): 43-55.
3. 王根林, 楊惠林, 孟斌, 等. 椎體后凸成形術治療骨質疏松性 Kümmell’s 病. 中國脊柱脊髓雜志, 2011, 21(1): 46-49.
4. 楊根林, 楊惠林, 姜為民, 等. 球囊擴張椎體后凸成形術治療骨質疏松性椎體骨折后骨壞死. 中華外科雜志, 2010, 48(8): 593-596.
5. 李厚坤, 王曉東, 楊小衛, 等. 單側椎弓根入路與雙側椎弓根入路 PKP 治療 Kummell’s 病的臨床對比研究. 中國矯形外科雜志, 2016, 24(18): 1660-1665.
6. Kim KT, Suk KS, Kim JM, et al. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop, 2003, 27(2): 65-69.
7. 邱貴興, 裴福興, 胡偵明, 等. 中國骨質疏松性骨折診療指南 (骨質疏松性骨折診斷及治療原則). 中華骨與關節外科雜志, 2015, 8(5): 371-374.
8. 劉洋, 李明輝, 梅紅軍. 經皮椎體后凸成形術后骨水泥滲漏的回顧性分析及預防策略. 中國骨質疏松雜志, 2013, 19(4): 375-380.
9. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
10. Pflugmacher R, Kandziora F, Schroeder RJ, et al. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol, 2006, 47(4): 369-376.
11. Phillips FM, Ho E, Campbell Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vetebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265.
12. Wang G, Yang H, Meng B, et al. Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kypboplasty. J Clinic Neuros, 2011, 18(5): 664-668.
13. 張磊磊, 李健, 賈驚宇, 等. Kummell 病的研究進展. 中國矯形外科雜志, 2015, 23(9): 816-819.
14. Luo J, Daines L, Charalambous A, et al. Vertebroplasty only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976), 2009, 34(26): 2865-2873.
15. Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol, 2009, 30(10): 1835-1839.
16. 賀寶榮, 許正偉, 郝定均, 等. 骨水泥在骨質疏松性骨折椎體內分布狀態與生物力學性能的關系. 中華骨科雜志, 2012, 32(8): 768-773.
17. Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa1976), 2005, 30(2): 201-205.
18. 印飛, 孫振中, 宋升, 等. 單雙側經皮椎體后凸成形術治療中位胸椎骨質疏松性壓縮骨折對比研究. 中國修復重建外科雜志, 2016, 30(1): 77-81.
19. 郭金庫, 丁文元, 申勇, 等. 球囊擴張后凸椎體成形術治療老年骨質疏松性胸腰椎爆裂骨折. 中國修復重建外科雜志, 2010, 24(11): 1341-1344.
20. 姚女兆, 夏曦, 唐紹鋒. 序貫椎體成形術治療 Kummell 病的療效觀察. 中國修復重建外科雜志, 2015, 29(10): 1265-1268.
21. Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J, 2014, 14(8): 1551-1558.
22. 徐松, 納強, 張雄文, 等. 分步筑墻 PKP 治療胸腰椎骨質疏松性骨折骨不連. 中國骨與關節損傷雜志, 2016, 31(3): 231-234.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease

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