An Effective Treatment Option for Kümmell Disease With Neurological Deficits: Modified Transpedicular Subtraction and Disc Osteotomy Combined With Long-Segment Fixation

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Abstract

Study Design.

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.

Summary of Background Data.

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.

Conclusion.

Modified transpedicular subtraction and disc osteotomy combined with long-segment fixation is an effective treatment option for Kümmell disease with neurological deficits.

Conclusion.

Level of Evidence: 4

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