Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell’s disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)—vertebroplasty and/or kyphoplasty—is the main treatment modality, but additional short-segment fixation (SSF) has been recommen...

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Bibliographic Details
Published in:Neurosurgical review 2022-04, Vol.45 (2), p.1009-1018
Main Authors: Cabrera, Juan P., Camino-Willhuber, Gastón, Guiroy, Alfredo, Carazzo, Charles A., Gagliardi, Martin, Joaquim, Andrei F.
Format: Article
Language:English
Subjects:
Bone Cements - therapeutic use
Fractures, Compression - drug therapy
Fractures, Compression - surgery
Humans
Kyphoplasty - methods
Medicine
Medicine & Public Health
Neurosurgery
Osteoporotic Fractures - surgery
Retrospective Studies
Review
Spinal Fractures - drug therapy
Spinal Fractures - surgery
Treatment Outcome
Vertebroplasty - methods
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Summary:Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell’s disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)—vertebroplasty and/or kyphoplasty—is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell’s disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD –0.61, 95% CI (–1.44, 0.23), I 2 91%, p  = 0.15; ODI, non-significant difference favoring VA + SSF: MD –9.85, 95% CI (–19.63, –0.07), I 2 96%, p  = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD –3.21 mm, 95% CI (–7.55, 1.14), I 2 92%, p  = 0.15; LKA, non-significant difference favoring VA + SSF: MD –0.85°, 95% CI (–5.10, 3.40), I 2 95%, p  = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF ( p  
ISSN:1437-2320
1437-2320
DOI:10.1007/s10143-021-01661-8