Analysis of strategy and efficacy clinical treatments of Kümmell disease: a cohort study

BACKGROUND: Most clinical reports on the surgical treatment of kümmell disease lack consistency between classification and treatment protocol. In this study, we investigate the most appropriate and effective clinical treatment strategies according to the characteristics of different types of Kümmell disease. METHODS: A retrospective analysis was performed of 48 patients with Kümmell disease treated in Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China for which complete follow-up data were available. All cases were classified into six types: type I, vertebral body height loss less than 20% and no intervertebral disc degeneration from adjacent segments; type II, vertebral body height loss more than 20% and accompanied by degeneration or mild instability of intervertebral discs at adjacent segments; type III, posterior vertebral cortical rupture and dural sac compression, and some accompanied by spinal cord nerve injury. Type III includes type IIIA (recoverable stable type), type IIIB (recoverable unstable type), type IIIC (spinal stenosis type), and type IIID (kyphosis type). Methods of surgery: patients of types I, II, and IIIA were treated with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), type IIIB were treated with posterior fixation and fusion, type IIIC were treated with posterior decompression and fixation fusion, and type IIID were treated with posterior osteotomy, orthopedic fixation, and fusion. All patients were followed up for 10–44 months (mean, 20.5±4.5 months). The preoperative and postoperative visual analog scale (VAS) scores, Owestry disability index (ODI) scores, secondary height loss and kyphosis, and neurological improvement were followed up and statistically analyzed. RESULTS: The VAS and ODI scores of all cases were improved compared with those pre-surgery (P<0.05). A total of 8 cases showed loss of vertebral height or secondary kyphosis. The American Spinal Injury Association (ASIA) grades of patients with neural impairment were all improved at the last follow-up. CONCLUSIONS: According to the characteristics of different types of Kümmell disease, appropriate clinical treatment strategies can achieve satisfactory curative effects and reduce the occurrence of complications. This study is only a retrospective study, lacks a control group, and the sample size is small. Therefore, it has limitations and does not provide guidance.