Abstract:

BACKGROUND: Percutaneous kyphoplasty is one of the effective measures for the treatment of Kummell’s disease, but there is a displacement of bone cement mass after operation, which leads to pain and even failure, so some scholars have proposed to reduce the pain that may be aggravated by pedicle injection of bone cement, but its curative effect is not clear. 

OBJECTIVE: To explore the clinical effect of transpedicular bone cement perfusion combined with percutaneous kyphoplasty in the treatment of Kummell’s disease. 
METHODS: From January 1, 2015 to December 31, 2018, 27 patients with Kummell’s disease, including 7 males and 20 females, aged mean (70.44±6.44) years, who were treated in the Department of Spinal Surgery, the First Affiliated Hospital of Dali University, were retrospectively analyzed. All patients were followed up from 8 to 36 months. All patients were treated with percutaneous kyphoplasty operation. Gelatin sponge and high viscosity bone cement were used to reduce the leakage of bone cement; bone cement perfusion in the pedicle was performed. The visual analogue scale score and Oswestry disability index of back pain before and after treatment and the last follow-up were recorded, and the anterior and posterior vertebral height and wedge angle were measured before and after operation. CT scanning was used to observe the leakage of bone cement and the bone cement in the pedicle after operation, and the displacement of bone cement during the follow-up period. 
RESULTS AND CONCLUSION: (1) A total of 29 diseased vertebrae of 27 patients were included in the study. The average operation time was (49.46±14.8) minutes and the average amount of bone cement injection was (4.32±1.72) mL. Cement leakage was found in a total of three diseased vertebrae, all of which were transcortical defect leakage (type C). (2) The visual analogue scale score and Oswestry disability index on the first day and the last follow-up were significantly better than those before operation (P < 0.05). Oswestry disability index during the last follow-up was significantly improved than that on the first day after operation (P < 0.05). (3) The wedge angle of the diseased vertebrae after operation was significantly lower than that before operation; anterior vertebral height and posterior vertebral height of the diseased vertebrae after operation were significantly higher than those before operation, and the difference was statistically significant (P < 0.05). (4) It is concluded that intrapedicular bone cement infusion combined with percutaneous kyphoplasty can connect the vertebral body and pedicle bone cement into one, and enhance the stability of bone cement mass, and effectively prevent the displacement of bone cement in vertebral body, which is an effective technique for the treatment of Kummell’s disease.

Key words: Kummell’s disease, percutaneous kyphoplasty, intra-pedicle cement, bone cement leakage, bone cement displacement