Abstract
BackgroundUp to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine. This study aimed to evaluate the short to mid-term radiographic and clinical outcomes in the treatment of Kümmell’s disease with thoracolumbar kyphosis.MethodsFrom February 2016 to May 2018, 30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into group A and B according to whether the kyphosis was combined with neurological deficits. All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance. The radiographic outcomes and clinical outcomes of the cases were retrospectively evaluated. The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS) before operation,immediately after operation,and the last follow-up of each case were measured and evaluated. The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups. Statistical software SPSS21.0 was used to analyze the data.ResultsIn group A: Mean SVA before operation was 75 mm and 26.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 39°, and 7.1° at the final postoperative evaluation (P = 0.000); Mean NRS before operation was 4.7, compared with 0.9 at the final postoperative evaluation (P = 0.000). In group B: Mean preoperative SVA was 62.5 mm and decreases to 30.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 33°, and 9.7° 2 years post-operation (P = 0.000); Mean NRS prior to surgery was 4.0, and 0.8 at the last follow-up evaluation (P = 0.000). The improvement of the NRS scores of groups A and B was related to the improvement of the cobb angle (P = 0.020); (P = 0.009) respectively.ConclusionIn the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.
Highlights
Up to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine
For the patients with kyphosis,most opinions agree that in the treatment of kyphosis with neurological deficits the injured vertebrae should be removed by posterior vertebral column resection (VCR) to relieve spinal cord compression, kyphosis should be corrected and spinal stability should be reconstructed [12,13,14,15,16,17], so as to obtain better clinical effects
No neurological deficits appeared in group B after operation and at the last follow-up (Table 1)
Summary
Up to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine. This study aimed to evaluate the short to mid-term radiographic and clinical outcomes in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Since Kümmell’s disease was first proposed by Hermann Kümmell in 1895,it has been gradually recognized and understood by spinal surgeons [1]. Kümmell’s disease is defined as ischemic necrosis of the vertebral body after minor spinal injury [5, 6, 8]. The injured vertebra gradually collapse, and tend to become wedge shaped due to bone necrosis, followed by kyphosis deformity of the spine. As for kyphosis with no neurological impairment, most of the literature focus on eliminating the unstable factors of injured vertebra, so as to relieve local chronic and refractory lower back pain [4, 18,19,20,21]
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