Treatment of Kümmell’s disease with sequential infusion of bone cement:A retrospective study

BACKGROUND Percutaneous vertebroplasty(PVP)is an effective method for the treatment of neurologically intact Kümmell’s disease,but bone cement leakage during surgery is a problem that deserves attention.AIM To reduce bone cement leakage and evaluate the effect of the sequential infusion of bone cement during PVP for the treatment of stage I or II Kümmell’s disease.METHODS Patients with Kümmell’s disease treated in our hospital from September 2015 to September 2018 were retrospectively analyzed.Patients meeting the inclusion and exclusion criteria were divided into two groups:Traditional single infusion and sequential infusion(SI).The visual analog scale(VAS)and Oswestry disability index(ODI)were evaluated and compared,and duration of operation,bone cement content and complications were recorded.RESULTS Forty-five patients were included in this study;there were 24 in the traditional single infusion group and 21 in the SI group.The VAS and ODI were significantly different for both groups when compared pre-and postoperatively,whereas the differences between 1 wk postoperatively and at the final follow-up were not statistically.When the VAS and ODI of the two groups were compared,there were no significant differences at any time point.The leakage rate of bone cement was significantly lower in the SI group(14.3%,3 of 21)than that in the traditional single infusion group(41.7%,10 of 24).CONCLUSION SI in unipedicular PVP is a safe and effective procedure for neurologically intact Kümmell’s disease,and this technique could decrease the incidence of bone cement leakage.

Cortical bone trajectory fixation in cemented vertebrae in lumbar degenerative disease:A case report

BACKGROUND Percutaneous vertebroplasty(PVP)has been widely used in osteoporotic vertebral compression fracture(OVCF).Following surgery,the bone cement would be positioned permanently.However,in some cases of lumbar degenerative disease,the cemented vertebrae needs to be fixed after decompression and fusion procedure.It is difficult to implant traditional pedicle screws into the cemented vertebrae because of the bone cement filling.At present,the main treatment strategy is to skip the cemented vertebra and conduct a long segment fixation.This article presents a cortical bone trajectory(CBT)fixation technique for cemented vertebrae.CASE SUMMARY PVP involving the L3 and L4 was performed in an 82-year-old man due to OVCF.During the surgery,bone cement leakage occurred,resulting in compression of the root of the right L3 nerve.We performed a partial facetectomy to retrieve the leaked bone cement and to relieve the patient’s neurological symptoms.After 3 mo,the patient developed lumbar disc herniation in L3/4,potentially due to instability caused by the previous surgery.Therefore,it was necessary to perform intervertebral fusion and fixation.It was difficult to implant traditional trajectory pedicle screws in L3 and L4 because of the bone cement filling.Hence,we implanted CBT screws in the L3 and L4 vertebrae.As a result,the patient’s symptoms resolved and he reported satisfaction with the surgery at follow-up after 8 mo.CONCLUSION It is feasible to utilize CBT in cemented vertebrae for the treatment of lumbar degenerative disease.

Clinical efficacy and safety of kyphoplasty for the treatment of osteoporotic vertebral compression fractures at different surgical timings based on the theory of“dynamic-static integration”

Objective:To investigate the clinical efficacy and safety of percutaneous kyphoplasty at different surgical timings in the treatment of osteoporotic vertebral compression fracture(OVCF)based on the theory of“dynamic-static integration”.Methods:Patients with OVCF who underwent percutaneous kyphoplasty in our hospital were selected and divided into Groups A,B,and C for those undergoing surgery within 7,7—21,and>21 days of fracture occurrence.The variations in the amount of bone cement injected,pre-and post-operative pain levels,functional activity,deformity correction of the injured vertebrae,bone cement leakage,and vertebral body height loss were compared among the three groups.Results:Regarding pain relief and functional activity,the postoperative Visual Analog Scale and Oswestry Disability Index scores of the three groups significantly improved.Furthermore,the deformities of the injured vertebrae in the three groups were significantly corrected,with Groups A and B exhibiting superior correction compared to Group C.Moreover,the bone cement leakage rates in groups A and C were higher than that in Group B.At the 3-month follow-up,the loss of vertebral height in Group C was significantly higher than those in groups A and B.Conclusion:Kyphoplasty is effective for OVCF treatment.Early surgery can effectively restore the vertebral height of the injured vertebra,reduce kyphosis,and reduce height loss of the injured vertebra after surgery;nevertheless,treatment within 1—3 weeks of the fracture can reduce the occurrence of bone cement leakage,making the surgery safer.Therefore,surgical treatment within 1—3 weeks of fracture is safer and can achieve satisfactory therapeutic effects.From the perspective of traditional Chinese medicine,PKP surgery can transform the fracture end from a micromotion state to a fixed state,which fully embodies the theory of“dynamic-static integration”.