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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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| Published in: | Neurosurgical review 2022-04, Vol.45 (2), p.1009-1018 |
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| container_title | Neurosurgical review |
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| creator | Cabrera, Juan P. Camino-Willhuber, Gastón Guiroy, Alfredo Carazzo, Charles A. Gagliardi, Martin Joaquim, Andrei F. |
| description | 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
|
| doi_str_mv | 10.1007/s10143-021-01661-8 |
| format | article |
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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
< 0.05), but with lower cement leakage (
p
< 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell’s disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.</description><identifier>ISSN: 1437-2320</identifier><identifier>EISSN: 1437-2320</identifier><identifier>DOI: 10.1007/s10143-021-01661-8</identifier><identifier>PMID: 34596773</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Neurosurgical review, 2022-04, Vol.45 (2), p.1009-1018</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c277t-ecb277b146bf7c298acee72931f12b3112f633183f9cf09389445a5796398f063</citedby><cites>FETCH-LOGICAL-c277t-ecb277b146bf7c298acee72931f12b3112f633183f9cf09389445a5796398f063</cites><orcidid>0000-0003-4685-6106 ; 0000-0003-2645-0483 ; 0000-0002-0404-652X ; 0000-0002-5684-7679 ; 0000-0001-6339-2214 ; 0000-0001-9162-6508</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34596773$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cabrera, Juan P.</creatorcontrib><creatorcontrib>Camino-Willhuber, Gastón</creatorcontrib><creatorcontrib>Guiroy, Alfredo</creatorcontrib><creatorcontrib>Carazzo, Charles A.</creatorcontrib><creatorcontrib>Gagliardi, Martin</creatorcontrib><creatorcontrib>Joaquim, Andrei F.</creatorcontrib><title>Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis</title><title>Neurosurgical review</title><addtitle>Neurosurg Rev</addtitle><addtitle>Neurosurg Rev</addtitle><description>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
< 0.05), but with lower cement leakage (
p
< 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell’s disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.</description><subject>Bone Cements - therapeutic use</subject><subject>Fractures, Compression - drug therapy</subject><subject>Fractures, Compression - surgery</subject><subject>Humans</subject><subject>Kyphoplasty - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Osteoporotic Fractures - surgery</subject><subject>Retrospective Studies</subject><subject>Review</subject><subject>Spinal Fractures - drug therapy</subject><subject>Spinal Fractures - surgery</subject><subject>Treatment Outcome</subject><subject>Vertebroplasty - methods</subject><issn>1437-2320</issn><issn>1437-2320</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kTtOxTAQRS0E4r8BCuSSxuBPXhzTIcRPINEAreXkjSEon4cnefA6NkHBXujYCSvBEEAUiGqsuedeWXMJ2RB8W3Cud1BwkSjGpWBcpKlg2RxZjhvNpJJ8_td7iawg3nIutOFikSypZGRSrdUyebqC0EEeXEVdf11D07mubBs6qXqkeNOGjiF87qkvHwZtCgGjOv3b6aq2AVo29PT1pa6hqt4en5GOSwSHsEsdxRl2UEe4oAGmJdxT14xpDZ1jrnHVDEtcIwveVQjrX3OVXB4eXOwfs7Pzo5P9vTNWSK07BkUeZy6SNPe6kCZzBYCWRgkvZK6EkD5VSmTKm8JzozKTJCM30iZVJvM8Vatka8idhPauB-xsXWIR_-waaHu0cqQzrXVmdETlgBahRQzg7SSUtQszK7j9qMMOddhYh_2sw2bRtPmV3-c1jH8s3_ePgBoAjFJzDcHetn2IV8D_Yt8BEnaafQ</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Cabrera, Juan P.</creator><creator>Camino-Willhuber, Gastón</creator><creator>Guiroy, Alfredo</creator><creator>Carazzo, Charles A.</creator><creator>Gagliardi, Martin</creator><creator>Joaquim, Andrei F.</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4685-6106</orcidid><orcidid>https://orcid.org/0000-0003-2645-0483</orcidid><orcidid>https://orcid.org/0000-0002-0404-652X</orcidid><orcidid>https://orcid.org/0000-0002-5684-7679</orcidid><orcidid>https://orcid.org/0000-0001-6339-2214</orcidid><orcidid>https://orcid.org/0000-0001-9162-6508</orcidid></search><sort><creationdate>20220401</creationdate><title>Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis</title><author>Cabrera, Juan P. ; Camino-Willhuber, Gastón ; Guiroy, Alfredo ; Carazzo, Charles A. ; Gagliardi, Martin ; Joaquim, Andrei F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c277t-ecb277b146bf7c298acee72931f12b3112f633183f9cf09389445a5796398f063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Bone Cements - therapeutic use</topic><topic>Fractures, Compression - drug therapy</topic><topic>Fractures, Compression - surgery</topic><topic>Humans</topic><topic>Kyphoplasty - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Osteoporotic Fractures - surgery</topic><topic>Retrospective Studies</topic><topic>Review</topic><topic>Spinal Fractures - drug therapy</topic><topic>Spinal Fractures - surgery</topic><topic>Treatment Outcome</topic><topic>Vertebroplasty - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cabrera, Juan P.</creatorcontrib><creatorcontrib>Camino-Willhuber, Gastón</creatorcontrib><creatorcontrib>Guiroy, Alfredo</creatorcontrib><creatorcontrib>Carazzo, Charles A.</creatorcontrib><creatorcontrib>Gagliardi, Martin</creatorcontrib><creatorcontrib>Joaquim, Andrei F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgical review</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cabrera, Juan P.</au><au>Camino-Willhuber, Gastón</au><au>Guiroy, Alfredo</au><au>Carazzo, Charles A.</au><au>Gagliardi, Martin</au><au>Joaquim, Andrei F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis</atitle><jtitle>Neurosurgical review</jtitle><stitle>Neurosurg Rev</stitle><addtitle>Neurosurg Rev</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>45</volume><issue>2</issue><spage>1009</spage><epage>1018</epage><pages>1009-1018</pages><issn>1437-2320</issn><eissn>1437-2320</eissn><abstract>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
< 0.05), but with lower cement leakage (
p
< 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell’s disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34596773</pmid><doi>10.1007/s10143-021-01661-8</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4685-6106</orcidid><orcidid>https://orcid.org/0000-0003-2645-0483</orcidid><orcidid>https://orcid.org/0000-0002-0404-652X</orcidid><orcidid>https://orcid.org/0000-0002-5684-7679</orcidid><orcidid>https://orcid.org/0000-0001-6339-2214</orcidid><orcidid>https://orcid.org/0000-0001-9162-6508</orcidid></addata></record> |
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| source | Springer Nature |
| 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 |
| title | Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis |
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