Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 147-151
World Neurosurgery

Case Report
Posterior Vertebral Column Resection Through Unilateral Osteotomy Approach for Old Lumbar Fracture Combined with Kummell Disease

https://doi.org/10.1016/j.wneu.2017.09.148Get rights and content

Background

Kummell disease is a clinical syndrome characterized by minor spinal trauma with a symptom-free period from months to years, followed by progressive painful kyphosis. Many surgical options for Kummell disease have been reported in the previous literature; however, no study has mentioned the surgical strategy for patients whose fractured vertebrae were severely compressed and only a slice of superior and inferior end plate was left.

Case Description

Here we report the case of a 69-year-old woman who suffered persistent severe back pain since she slipped and fell 1 year before medical consult. The patient presented with constrained body posture and pressure pain on the thoracolumbar region. Visual analog scale pain under weight bearing was 90/100, and her Oswestry Disability Index score was 74%. Kummell disease was diagnosed on the basis of clinical presentation, trauma history, radiograph, computed tomography, and magnetic resonance imaging. We performed the posterior vertebral column resection through the unilateral osteotomy approach for the patient, and the clinical outcome and radiologic restoration were recorded. One year after the surgery, outpatient follow-up review revealed that the visual analog scale reduced to 10/100 and Oswestry Disability Index reduced to 13%. The posteroanterior and lateral radiograph in the standing position showed bony fusion was achieved at the osteotomy site. No pseudarthrosis or instrumentation-related failure occurred.

Conclusion

Posterior vertebral column resection through unilateral osteotomy approach is an effective method for patients with Kummell disease, especially when the fractured vertebrae compressed severely and only a slice of superior and inferior end plate was left.

Introduction

Kummell disease is a clinical syndrome characterized by progressive painful kyphosis following minor spinal trauma, and the main complaint is back pain.1 Due to the rarity of the condition and paucity of literature, specific treatment protocols are limited.2 It has been generally accepted that conservative management is applied to patients with pain only, and minimally invasive procedures are supplemented once conservative treatment fails. If there is evidence of neurologic compromise, open surgery of decompression and stabilization is recommended.3, 4, 5, 6 Although many surgery options for Kummell disease have been reported in the literature, no study has concerned the surgical strategy for patients with fractured vertebrae compressed severely and only a slice of superior and inferior end plates left.

Here we report a rare case of Kummell disease with only a slice of superior and inferior end plates left. The posterior vertebral column resection through the unilateral osteotomy approach, called a modified PVCR technique, was performed. The surgical detail and outcome are introduced.

Section snippets

Clinical Presentation

A 69-year-old woman suffered from persistent severe back pain since she slipped and fell 1 year before medical consult. Initially, she felt slight pain on the back without radiation and took some nonsteroidal antiinflammatory drugs (NSAIDs), but the pain increased. The pain was worsened while standing and walking and relieved in the supine position. On physical examination, the patient presented constrained body posture and pressure pain on the thoracolumbar region. Neurologic examination did

Surgical Procedure

Modified posterior vertebral column resection was performed for this patient (Figure 4). The operation was performed under general anesthesia with somatosensory-evoked potentials and motor-evoked potentials for neurophysiologic monitoring. The patient was placed prone on the operating table, and a standard posterior middle incision was made at the predetermined level. Pedicle screws were inserted 2 levels above and below the target vertebrae. A laminectomy was then performed to decompress and

Discussion

The treatment choice for Kummell disease depends on the presence of neurologic deficits. In the absence of neurologic impairment, conservative management should be the priority including bed rest, traction, brace, analgesics, and antiosteoporosis drugs.7 Fabbriciani et al8 demonstrated that the osteoanabolic treatment used in patients with Kummell disease was of great help in enhancing vertebral fracture's healing and contributing to back pain relief. When conservative management fails,

Conclusion

The posterior vertebral column resection through unilateral osteotomy approach is an effective method for patients with Kummell disease, especially when the fractured vertebrae compressed severely and a slice of superior and inferior end plates is left. Successful surgical treatment of this patient provides an alternative for spinal surgeons in the future.

Acknowledgments

The authors would like to thank Dr. Qian Wang for English editing. We are also grateful to the reviewers for useful comments.

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