Comparison Vertebroplasty with Kyphoplasty in Delayed Post-traumatic Osteonecrosis of a Vertebral Body(Kummell's Disease)

Lee, Keun; Lee, Sang Gu; Kim, Woo Kyung; Yoo, Chan Jong; Park, Chan Woo

Abstract

OBJECTIVE
Kummell's disease is a rare spinal disorder with delayed post-traumatic osteonecrosis of a vertebral body and the pathophysiology is still unclear. Percutaneous vertebroplasty was found to be an effective procedure as a treatment, but there are not sufficient studies. We evaluated the efficacy and complications of vertebroplasty or kyphoplasty in the treatment of delayed post-traumatic intravertebral osteonecrosis.
METHODS
A retrospective review was conducted of 29 patients complicated with delayed post-traumatic intravertebral osteonecrosis among the 393 cases of osteoporotic vertebral compression fracture treated with vertebroplasty or kyphoplasty from January 2001 to June 2005. With 29 cases of intravertebral osteonecrosis, we reviewed the duration from initiation of symptoms to admission and the history of trauma. Also, we analysed the restoration of height of vertebral body, the correction of kyphotic angle, the clinical results with VAS score, the amount of injected polymethylmethacrylate(PMMA), and the complications due to PMMA leakage between the vertebroplasty and kyphoplasty.
RESULTS
There were 29 patients(22 females and 7 males) complicated with delayed post-traumatic osteonecrosis of vertebral body(7.3%), and mean age was 73.3 years. The cases with prominent traumatic history were 19 and the mean duration from initiation of symptoms to admission was 5.9 weeks. The whole surgically treated levels were 31 levels; 19 levels with vertebroplasty(group A), 12 levels with kyphoplasty(group B). The leakage of PMMA was occurred in 9 levels; 6 levels in vertebroplasty and 3 levels in kyphoplasy. However, there were no serious complications. In the VAS score, there was 4.9 in group A compared to 5.3 in group B. But there was no significant difference statistically. We measured vertebral body height and kyphotic angle to figure out the degree of restoration after procedures. Both group A and B showed somewhat effective restoration of vertebral height and correction of kyphotic angle. However, there were no stastical differences between two groups. After 14 months, restored vertebral heights and corrected kyphotic angles reaggravated and this suggest that the process of vertebral osteonecrosis is going on even after receiving vertebroplasty and kyphoplasty.
CONCLUSION
For the treatment of Kummell's disease, both vertebroplasty and kyphoplasty seemed to be somewhat effective. Although the PMMA leakage occurred more often in vertebroplasty group than kyphoplasty group, there were no statiscal difference in recovery of VAS score. However, the process of intravertebral osteonecrosis can be developed continuously after procedure which may be the cause of serious complications. Therefore, continuous follow-up observation after procedure should be recommended.