Save
Overcoming fracture progression in complicated Kümmell's disease: feasibility of single-stage transpedicular vertebral body reconstruction
EANS Academy. Kim S. 09/26/19; 275928; EP02109
Prof. Se-Hoon Kim
Prof. Se-Hoon Kim

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy


Abstract
Discussion Forum (0)
Rate & Comment (0)
Objectives: Posttraumatic delayed vertebral collapse, known as Kümmell´s disease, is increasing in number of patients. This disease shows progressive kyphosis due to vertebral collapse at the time of diagnosis and causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Purpose of this presentation is to suggest appropriate treatments for patients with posttraumatic delayed vertebral collapse to overcome fracture progression in complicated Kümmell´s disease.
Materials: Nine patients with Kümmell´s disease, out of total 41 patients with unstable thoraco-lumbar burst fracture, underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage and short segment fixation. Neurologic status was classified using the ASIA Scale, while functional outcome was analyzed using a VAS for back pain. Segmental Cobb angles were measured preoperatively, immediate postoperatively, and at the last follow-up.
Results: Preoperative neurologic status was ASIA grade E in 5 patients, grade D in 2, and grade C in 2. Postoperatively, neurologic stability was demonstrated in 6 patients (66.7%), and 3 (33.3%) showed improvement in the ASIA grade. Mean preoperative VAS score was 6.6, 3.2 at postoperative 1 month, and 1.4 at the final follow-up. Mean preoperative segmental kyphotic angle was -25.47°, which was reduced to -15.39° immediate postoperatively, and maintained as -16.92° at the last follow-up. There was no surgical complications, implant-related complications, or neurological deterioration in all patients.
Conclusions: Results of our series suggest the feasibility, efficacy, and safety of this surgical option for Kümmell´s disease complicated with fracture progression. This technique from a single posterior approach offers several advantages over traditional anterior or anterior-posterior combined approaches using strut graft or nonexpandable implants.


[Intraoperative Photograph of Transpedicular Vertebral Body Reconstruction]

Objectives: Posttraumatic delayed vertebral collapse, known as Kümmell´s disease, is increasing in number of patients. This disease shows progressive kyphosis due to vertebral collapse at the time of diagnosis and causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Purpose of this presentation is to suggest appropriate treatments for patients with posttraumatic delayed vertebral collapse to overcome fracture progression in complicated Kümmell´s disease.
Materials: Nine patients with Kümmell´s disease, out of total 41 patients with unstable thoraco-lumbar burst fracture, underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage and short segment fixation. Neurologic status was classified using the ASIA Scale, while functional outcome was analyzed using a VAS for back pain. Segmental Cobb angles were measured preoperatively, immediate postoperatively, and at the last follow-up.
Results: Preoperative neurologic status was ASIA grade E in 5 patients, grade D in 2, and grade C in 2. Postoperatively, neurologic stability was demonstrated in 6 patients (66.7%), and 3 (33.3%) showed improvement in the ASIA grade. Mean preoperative VAS score was 6.6, 3.2 at postoperative 1 month, and 1.4 at the final follow-up. Mean preoperative segmental kyphotic angle was -25.47°, which was reduced to -15.39° immediate postoperatively, and maintained as -16.92° at the last follow-up. There was no surgical complications, implant-related complications, or neurological deterioration in all patients.
Conclusions: Results of our series suggest the feasibility, efficacy, and safety of this surgical option for Kümmell´s disease complicated with fracture progression. This technique from a single posterior approach offers several advantages over traditional anterior or anterior-posterior combined approaches using strut graft or nonexpandable implants.


[Intraoperative Photograph of Transpedicular Vertebral Body Reconstruction]

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings