Wang Hui, Ding Wenyuan
Third Hospital of HeBei Medical University, Shijiazhuang, Hebei, P. R. China.
Third Hospital of HeBei Medical University, Shijiazhuang, Hebei, P. R. China.
World Neurosurg. 2018 Jan;109:147-151. doi: 10.1016/j.wneu.2017.09.148. Epub 2017 Sep 30.
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.
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.
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.
Kummell病是一种临床综合征，其特征为轻微脊柱创伤后有数月至数年的无症状期，随后出现进行性疼痛性脊柱后凸。既往文献报道了多种治疗Kummell病的手术方式；然而，尚无研究提及针对椎体严重压缩且仅残留一小片上下终板患者的手术策略。
本文报告一例69岁女性患者，自1年前滑倒摔伤后一直遭受持续严重的背痛，就诊时患者身体姿势受限，胸腰段有压痛。负重时视觉模拟评分疼痛为90/100，Oswestry功能障碍指数评分为74%。根据临床表现、外伤史、X线片、计算机断层扫描和磁共振成像诊断为Kummell病。我们采用单侧截骨入路对该患者实施了后路脊柱全椎体切除术，并记录了临床疗效和影像学恢复情况。术后1年门诊随访复查显示，视觉模拟评分降至10/100，Oswestry功能障碍指数降至13%。站立位正侧位X线片显示截骨部位达到骨性融合。未发生假关节形成或内固定相关失败。
单侧截骨入路后路脊柱全椎体切除术是治疗Kummell病患者的有效方法，尤其是对于椎体严重压缩且仅残留一小片上下终板的患者。
