Lee Keun, Adsul Nitin, Kim Hyeun-Sung, Pee Yong-Hun, Lee Kwang Lae, Jang Il-Tae
Department of Neurosurgery, Nanoori Juan Hospital, Incheon, Republic of Korea.
Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.
World Neurosurg. 2018 Nov;119:506-510. doi: 10.1016/j.wneu.2018.06.061. Epub 2018 Jun 19.
In cases of Kümmell disease without neurologic deficit, percutaneous vertebroplasty or kyphoplasty has achieved short-term favorable outcomes. In the long term, recollapse of the augmented vertebral body and aggravation of kyphosis at the index level is often reported. Owing to medical comorbidities, elderly patients are often unsuited for extensive open spine surgery under general anesthesia.
A 95-year-old man presented with a 1-month history of intractable back pain and gait disturbance. Magnetic resonance imaging revealed intravertebral avascular necrosis with fluid collection at the L4 vertebra. After postural reduction using a pillow in the supine position for 2 days, percutaneous pedicle screw fixation with bone cement augmentation was performed at the L3-5 level including L4 fracture under epidural anesthesia. Additional posterior column compression was performed to achieve restoration of spinal canal and lumbar lordosis. Severe back pain was reduced after surgery, and the patient was able to walk the day after surgery.
To our knowledge, this is the first case of Kümmell disease in an extremely elderly patient in whom good clinical result was obtained after postural reduction, vertebral augmentation, and short segment percutaneous pedicle screw fixation under epidural anesthesia.
在无神经功能缺损的Kümmell病病例中，经皮椎体成形术或后凸成形术已取得短期良好疗效。从长期来看，常报道椎体强化后再塌陷以及手术节段后凸畸形加重。由于并存多种内科疾病，老年患者往往不适合在全身麻醉下进行广泛的开放性脊柱手术。
一名95岁男性，有1个月顽固性背痛和步态障碍病史。磁共振成像显示L4椎体存在椎体内无血管坏死并伴有积液。在仰卧位使用枕头进行体位复位2天后，在硬膜外麻醉下对包括L4骨折的L3 - 5节段进行经皮椎弓根螺钉固定并骨水泥强化。同时进行额外的后柱加压以恢复椎管和腰椎前凸。术后严重背痛减轻，患者术后次日即可行走。
据我们所知，这是首例在极老年患者中通过体位复位、椎体强化和硬膜外麻醉下短节段经皮椎弓根螺钉固定获得良好临床效果的Kümmell病病例。
