Clinical results of percutaneous kyphoplasty for the treatment of severe osteoporotic Kummell disease

Objective To evaluate the efficacy and satefy of percutaneous kyphoplasty for treating Kummel disease with severe osteoporosis. Methods The clinical data of 23 Kummell′s patients with severe osteoporosis attending orthopedics in ChuiYang Liu Hospital Affiliated to Tsinghua University from March 2013 to July 2016 were retrospectively analyzed. The patients underwent percutaneous kyphoplasty, the first day after surgery was evaluated during the hospitalization period, outpatient review for 3 months and 1 year. All measurement data were expressed as (±s), repeated measures analysis of variance was used for statistical analysis of preoperative and postoperative pain visual analogue scale, Oswesay dysfunction index, mean vertebral anterior, central and posterior height, kyphotic angle and operative complications. Results Outpatients were followed up for 12 to 24 months, with an average follow-up of (18.1 ± 5.6) months. The mean preoperative visual analogue scale of the patients with percutaneous kyphoplasty was (8.4 ± 1.5) scores after operation, (2.2 ± 1.1) and (3.1 ± 1.7) scores at 1st day after operation, 3 months and (4.6 ± 2.0) scores at 1 year after operation respectively, all P<0.001. The preoperative average Oswesay disability index score was (70.1 ± 10.5) scores, (27.4 ± 7.9) and (36.6 ± 8.1) scores at 1st day after operation, 3 months, and (46.5 ± 9.3) scores at one year after operation, all P<0.001. Postoperative one year pain visual analogue scale and Oswesay dysfunction index score compared with 1st day and 3 months after operation, the difference was statistically significant (P<0.05). The mean preoperative vertebral body height percentage was (44.4 ± 6.9)%, (50.1 ± 6.3)% and (88.2 ± 4.1)%, respectively, (65.5 ± 5.0)%, (66.2 ± 5.7)% and (89.3 ± 3.7)% respectively at 1st day after operation, (63.8 ± 7.4)%, (64.6 ± 5.0)% and (88.1 ± 3.9)% respectively at 3 months after operation, (57.8 ± 6.3)%, (63.0 ± 6.7)% and (87.1 ± 4.2)% respectively at 1 year after operation. Postoperative vertebral anterior and central height percentage compared with the preoperative significantly improved (P<0.05). There was no significant difference in the height of vertebral trailing edge. The height of vertebral body at 1 year after operation was significantly different from that at one day and three months after operation (P <0.05). The kyphotic angle improved significantly from 25.0°±7.5° to 16.5°±4.1° at 1st day after surgery (P=0.001), 18.2°±5.8° at 3 months after surgery (P=0.032), but the kyphotic angle increased to 21.3°±8.1° at 1 year after the procedure(P=0.051). However, asymptomatic peripheral bone cement leakage occurred in 2 patients and 5 patients sustained adjacent fractures after percutaneous kyphoplasty, the rest of the patients did not have surgical complications and adjacent vertebral fractures. Conclusion Percutaneous kyphoplasty is a safe and effective method for the treatment of Kummell′s disease, though it has long-term deterioration of adjacent vertebral fractures and kyphosis, but it can provide spinal stability and relieve pain in the short term, which is conducive to the recovery of patients. Key words: Kyphoplasty; Spinal fractures; Osteoporosis