title: Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell's disease with neurological deficits.
abstract: The aim of this study was to investigate the treatment of Kümmell's disease with neurological deficits and to determine whether intravertebral clefts are a pathognomonic sign of Kümmell's disease. A total of 17 patients who had initially been diagnosed with Kümmell's disease were admitted, one patient was excluded from this study. Posterior decompression and vertebroplasty for the affected vertebrae were conducted. Pedicle screw fixation and posterolateral bone grafts were performed one level above and one level below the affected vertebrae. Vertebral tissue was extracted for histopathological examination. The mean time of follow-up was 22 months (range, 18 to 42 months). The anterior and middle vertebral heights were measured on standing lateral radiographs prior to surgery, one day postoperatively and at final follow-up. The Cobb angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. The VAS, anterior and middle vertebral heights and the Cobb angle were improved significantly one day postoperatively and at the final follow-up compared with the preoperative examinations (P<0.05). No significant differences were observed between the one-day postoperative results and those at final follow-up (P>0.05). The neurological function of all patients was improved by at least one Frankel grade. All patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. One patient (not included in this study) showed an intravertebral cleft, but the pathology report indicated a non-Hodgkin's lymphoma. The intravertebral cleft sign is not pathognomonic of Kümmell's disease. Posterior decompression with short-segment fixation and fusion combined with vertebroplasty is an effective treatment for Kümmell's disease with neurological deficits.
authors: Departments of Orthopedics, Henan Province People's Hospital, Zhengzhou, Henan 450003,  P.R. China.
authors: Guang-Quan
authors: GQ
authors: Zhang
authors: Yan-Zheng
authors: YZ
authors: Gao
authors: Jia
authors: J
authors: Zheng
authors: Jian-Ping
authors: JP
authors: Luo
authors: Chao
authors: C
authors: Tang
authors: Shu-Lian
authors: SL
authors: Chen
authors: Hong-Qiang
authors: HQ
authors: Wang
authors: Ke
authors: K
authors: Liu
authors: Rui-Gang
authors: RG
authors: Xie
keywords: Kümmell’s disease; decompression operation; intravertebral vacuum phenomenon; vertebroplasty
references: AJNR Am J Neuroradiol. 2006 Jan;27(1):230-1
references: 16418390
references: Eur Spine J. 2010 Jun;19(6):907-15
references: 20157741
references: Spine (Phila Pa 1976). 1997 Aug 15;22(16):1885-91
references: 9280025
references: Radiology. 1978 Oct;129(1):23-9
references: 693884
references: J Spinal Disord Tech. 2004 Aug;17(4):291-6
references: 15280757
references: Zhonghua Wai Ke Za Zhi. 2010 Apr 15;48(8):593-6
references: 20646476
references: J Neurosurg Spine. 2010 Nov;13(5):612-21
references: 21039153
references: J Spinal Disord Tech. 2010 Feb;23(1):53-6
references: 20065870
references: Eur Spine J. 2010 Jul;19(7):1071-2
references: 19937066
references: Spine (Phila Pa 1976). 2003 Jul 15;28(14):1588-92
references: 12865850
references: Spine (Phila Pa 1976). 2003 Sep 15;28(18):2170-5
references: 14501932
references: J Spinal Disord. 2001 Oct;14(5):393-8
references: 11586138
references: Neurosurgery. 2009 May;64(5 Suppl 2):350-4; discussion 354-5
references: 19404113
references: J Korean Neurosurg Soc. 2008 Apr;43(4):212-4
references: 19096648
references: Orthopedics. 2008 Jan;31(1):61-6
references: 18269169
references: Radiology. 1993 May;187(2):483-7
references: 8475295
references: Eur Spine J. 2011 Aug;20(8):1341-8
references: 21533599
references: Spine (Phila Pa 1976). 2000 Nov 1;25(21):2832-5
references: 11064531
references: Int Orthop. 2003;27(2):65-9
references: 12700926