Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell’s disease

Abstract

Background: The aim of this study was to investigate the surgical treatment of neurologically compromised advanced Kümmell’s disease. The surgical treatment of Kümmell’s disease has various options according to clinical and radiologic status. Far collapsed Kümmell’s disease patients with neurological deficit need to be treated surgically. Materials and methods: We retrospectively analyzed 22 patients operated to our hospital with neurologically compromised Kümmell’s disease between January 2011 and January 2014. Surgical approach was vertebrectomy, mesh cage insertion and segmental cement-augmented pedicle screw fixation. Corpectomy tissue was examined histopathologically. Anterior vertebral heights, kyphotic angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. Results: The mean time of follow-up was 26 months (range, 13–40 months). The VAS, anterior vertebral heights, kyphotic angle and neurological state were improved significantly immediate postoperatively and at the last follow-up compared with the preoperative examinations (P < 0.05). Most of the patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. Conclusion: Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective option for advanced Kümmell’s disease with neurological deficits. © 2017, Istituto Ortopedico Rizzoli.