Is Percutaneous Kyphoplasty the Better Choice for Treatment of Stage III Kümmell's Disease Without Neurological Symptoms? A Retrospective Study of Two Invasive Procedures.

Abstract

Study design: Retrospective analysis.

Objective: Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon. Nevertheless, the surgical option in Stage III Kümmell's disease without neurological deficits remains controversial. The purpose of this study is to determine whether PKP or pedicle subtraction osteotomy (PSO) combined with long-segment fixation (LSF) is more effective in treating Kümmell's disease at Stage III without neurological impairments.

Methods: Between January 2017 and June 2020, 89 patients were treated with PKP or PSO + LSF. The outcomes, including operative time, blood loss, Oswestry Disability Indexes (ODIs), heights of fractured vertebrae, visual analog scale (VAS) scores, and kyphosis Cobb angles, were measured at the follow-up time for the PKP group and PSO + LSF group. Fisher's exact test or chi-square test for number and percentage data was employed to compare statistical analyses between two groups.

Results: Forty-six patients underwent PKP and 43 patients who treated by PSO + LSF. Postoperative measurements showed substantial improvements in kyphosis Cobb angle and vertebral height in the PKP group compared to preoperative measurements. Operating time, estimated blood loss, and duration of stay were all reduced in the PKP group compared to the PSO + LSF group. The PSO + LSF group had better correction of a kyphotic Cobb angle than the PKP group. Short-term monitoring showed that the PKP group had fewer ODI and VAS scores than the PSO + LSF group. In addition, no significant neurological symptoms were found after operation in both groups. The complication rates of PKP and PSO + LSF groups were 10.87% and 9.30%, respectively.

Conclusions: Kümmell's disease in Stage III without neurological symptoms responded to both PKP and PSO + LSF as safe and efficient treatments. Despite limited correction of kyphotic Cobb angle, PKP patients had better early clinical outcomes, increased fractured vertebral height, decreased blood loss, and less surgical trauma compared with the PSO + LSF group.