A safe and reproducible anterior column restoration technique for Kümmell's disease: transpedicular bone packing

Kümmell's disease (KD), delayed post-traumatic vertebral collapse, is diagnosed with characteristic radiologic findings such as intravertebral vacuum cleft (IVC). Because patients with KD are elderly, have many underlying diseases, poor bone quality, and relatively limited surgical outcomes compared to other spinal diseases. The aim of this study is to describe a minimally invasive surgical technique and to evaluate the clinical and radiological outcomes of this technique.

As a surgical treatment method for KD, we performed bone substitute packing via small pedicle holes with a posterior instrumented fusion. Ten consecutive patients underwent surgery for KD. Clinical outcomes and radiologic parameters were evaluated pre- and post-operatively.

The average operation time was 150.5±19.64 min with a mean estimated blood loss of 252±173.32 mL. The mean Visual Analog Scale (VAS) score for back pain was reduced from preoperative 8.7±0.82 to 2.8±1.14 (P<0.001), and the mean Oswestry Disability Index (ODI) score improved from 30.6±3.2 preoperatively to 11.6±4.81 (P<0.001) at the final follow-up. The sagittal Cobb angles decreased from 23.19±9.52 degrees preoperatively to 11.59±10.06 degrees (P<0.001) immediately after surgery, and 13.31±10.43 (P=0.002) degrees at the final follow-up. Except for 1 case of minor screw migration, there were no serious perioperative complications.

Transpedicular bone packing does not involve technically demanding procedures such as corrective osteotomy, vertebral column resection, and insertion of large metal cage. Therefore, it may be minimally invasive and reproducible surgical option.