Surgical Treatment of Kümmell Disease with Neurologic Deficits - Posterolateral Decompression and Posterior Reconstruction -

Kim, Ki-Tack; Suk, Kyung-Soo; Kim, Jin-Moon

doi:10.4184/jkss.2001.8.2.136

J Korean Soc Spine Surg. 2001 Jun;8(2):136-142. Korean.
Published online Jun 30, 2001.
https://doi.org/10.4184/jkss.2001.8.2.136

Original Article

Surgical Treatment of Kümmell Disease with Neurologic Deficits - Posterolateral Decompression and Posterior Reconstruction -

Ki-Tack Kim, M.D., Kyung-Soo Suk, M.D. and Jin-Moon Kim, M.D.

Author information

Author notes

Copyright and License

- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Address reprint requests to Ki-Tack Kim, M.D. Department of Orthopaedic Surgery, Kyung Hee University Hospital, #1 Hoegi-dong, Dongdaemoon-Ku, Seoul, Korea. Tel: 82-2-958-8371, Fax: 82-2-964-3865, Email: ktkim@khmc.or.kr

Abstract

Study Design

Retrospective study was performed in eight patients with Kümmell disease.

Objectives

To access the results of posterolateral decompression and posterior reconstruction in Kümmell disease with neurologic deficits.

Summary of Literature Review

Severe osteoporosis is the most frequent cause of spinal compression fracture. Vertebral compression fracture in senile osteoporosis is characterized by the late development and slow progression of paraplegia. When conservative treatment for paraplegia proves ineffective, an early operation is recommended.

Materials and Methods

From June 1996 to February 2000, eight consecutive Kümmell disease patients with neurologic deficits underwent posterolateral decompression and posterior reconstruction. We analyzed operation time, loss of blood through the medical records. Change of segmental kyphotic angle, bone union were assessed by plain radiographs, the clinical results were analyzed according to changes of pain and neurological status.

Results

Mean operation time was 217 minutes, mean bleeding loss was 682 ml. The mean preoperative segmental kyphotic angle measured 22.6 degrees, and decreased to 4.4 degrees at postoperative evaluation, and 6.8 degrees at final follow-up. Bony union was obtained in 9 months. At preoperative time, four cases showed Frankel grade C and four cases Frankel grade D. At last follow-up time, one case Frankel grade D and six cases Frankel grade E.

Conclusions

We concluded that posterolateral decompression and posterior reconstruction is a useful method for the treatment of Kümmell disease with neurologic deficits.

Keywords

Kümmell Disease; Surgical treatment; Posterolateral decompression; Posterior reconstruction

Figures

Fig. 1
Posterolateral decompression through pedicle.

A. Removal of medial part of both pedicles.

B. Curettage of cancellous bone.

C. Pushing the thin cortical shell anteriorly by curved curette.

D. Impacted bone graft was done with autogenous and allogenous bone.

E. Connection of rod to the pedicle screws.

Click for larger image

Fig. 2
A. Thoracolumbar spine lateral radiography of a 68-year-old woman shows compression fracture of T12.

B. Nine months follow-up lateral radiography and MRI shows collapse of T12 and spinal cord compression.

C. Postoperatively, reconstructed spine is good alignment and complete bone union.

Click for larger image

Fig. 3
A. Histological examination shows apposition of newly formed "woven bone" on preexisting lamellar bone.

B. Granulation tissue and necrotic tissue is seen around the callus.

Click for larger image

Fig. 4
A. Thoracolumbar spine lateral radiography of a 64-year-old woman shows compression fracture of L1. MRI shows cord compression at L1 level.

B. The cage are inserted due to end plate and intervertebral disc injury during curettage. Collapse is found one year after surgery due to insufficient pedicle screw fixation.

Click for larger image

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