Kümmell’s disease (KD), characterized by delayed vertebral collapse with intravertebral vacuum cleft (IVC), remains controversial in clinical management. Traditional percutaneous vertebroplasty (PVP) may lead to cement loosening and vertebral re-collapse due to insufficient mechanical interlocking between cement and bone. This study compared the clinical efficacy of bone cement pedicle-anchored PVP (BCPA-PVP) versus conventional PVP for Stage I and II KD. A retrospective analysis enrolled 79 patients with Stage I/II KD undergoing PVP or BCPA-PVP between March 2018 and January 2023. Patients were divided into four groups: Stage I PVP (n=18), Stage I BCPA-PVP (n=20), Stage II PVP (n=20), and Stage II BCPA-PVP (n=21). Clinical outcomes, including Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), anterior vertebral height (AVH), Cobb angle, and complications, were evaluated preoperatively, postoperatively (day 1), and at final follow-up. For Stage I KD, no significant differences emerged between PVP and BCPA-PVP groups at final follow-up: VAS (1.06±0.66 vs. 0.90±0.64), ODI (15.33±3.24 vs. 15.60±4.76), AVH (26.94±2.29 mm vs. 27.10±2.45 mm), or Cobb angle (5.22±1.17° vs. 5.10±1.52°) (all P > 0.05). No cement loosening occurred. In Stage II KD, the PVP group showed significantly worse outcomes at final follow-up compared to BCPA-PVP: VAS (2.60±1.85 vs. 1.14±1.01, P < 0.05), ODI (30.40±12.67 vs. 19.52±9.84, P < 0.05), and AVH (20.15±2.64 mm vs. 21.86±1.72 mm, P < 0.05). Cement leakage occurred in 30.4% (24/79), with higher rates in Stage II BCPA-PVP (42.8%, 9/21). Cement loosening was observed exclusively in Stage II PVP group (25%, 5/20). Conventional PVP can provide satisfactory outcomes for Stage I KD. However, BCPA-PVP is recommended for Stage II KD to reduce risks of cement loosening, vertebral re-collapse, and kyphotic progression.
Wang et al. (Tue,) studied this question.
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