title: An Effective Treatment Option for Kümmell Disease With Neurological Deficits: Modified Transpedicular Subtraction and Disc Osteotomy Combined With Long-Segment Fixation.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To illustrate the technique of modified transpedicular subtraction and disc osteotomy combined with long-segment fixation for the treatment of Kümmell disease with neurologic deficits and to evaluate clinical and radiographic results of patients treated with the technique.
  
  
  BACKGROUND
  Kümmell disease is a clinical condition in which patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal. Currently, for patients with neurological deficits, anterior decompression with bone grafting fusion, posterior decompression with pedicle subtraction osteotomy, or a combined anterior and posterior approach operation were used; however, there is no standard treatment and no single effective treatment for Kümmell disease.
  
  
  METHODS
  Between May 2009 and May 2012, we reviewed 12 patients experiencing Kümmell disease with neurological deficits who underwent modified transpedicular subtraction and disc osteotomy combined with long-segment fixation. Preoperative and postoperative Cobb angle, visual analog scale, Asia Spinal Injury Association, and sagittal balance were documented. The patients were followed up for 33 months on average.
  
  
  RESULTS
  The Cobb angles decreased from 43.33 ± 7.44° to 1.92 ± 2.74° (P < 0.01), the mean visual analog scale reduced from 7.17 ± 1.27° to 1.17 ± 1.03° (P < 0.01), and the sagittal vertical angle improved from 14.82 ± 3.56 cm to 5.15 ± 2.10 cm (P < 0.01). Kyphotic deformity was successfully corrected and solid fusion was achieved in all cases. Neurologic function of nine cases was improved to various degrees.
  
  
  CONCLUSIONS
  Modified transpedicular subtraction and disc osteotomy combined with long-segment fixation is an effective treatment option for Kümmell disease with neurological deficits.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital.
authors.forename: Wenhao
authors.initials: W
authors.lastname: Hu
authors.affiliation: Department of Renal Cancer and Melanoma, Peking University Cancer Hospital, Beijing, China.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Chinese PLA General Hospital.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013124:Spinal Injuries / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
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