Percutaneous Vertebroplasty Using a Rotary Cutter for Treating Kümmell's Disease with Intravertebral Vacuum Cleft.

BACKGROUND

Reported data indicate that the curative effect of percutaneous vertebroplasty (PVP) on the patients with intravertebral vacuum cleft (IVC) is worse than on those without IVC.

OBJECTIVES

This study was to prospectively investigate the advantage of rotary cutter-PVP (RC-PVP) in patients with Kümmell's disease with IVC.

STUDY DESIGN

A prospective outcome study.

SETTING

A tertiary care hospital.

METHODS

Patients who underwent conventional PVP served as the control group. For the RC-PVP group, the rotary cutters were applied before the cement injection to destroy the IVC structure and the surrounding necrotic bone. The following data were compared between the two groups: the cement filling patterns, effective therapeutic rate, the pre- to post-procedural changes of spinal geometry, and the subsequent fractures.

RESULTS

This study included a total of 64 patients (30 and 34 patients in RC-PVP group and control group, respectively). In the RC-PVP group, the cement in 26 cases was filled as a mixed pattern, while the filling pattern in the control group was mainly the cystic type (n = 31). There were no significant differences in the height restoration rate between the RC-PVP and control groups (32.7 ± 13.6 and 32.4 ± 13.9, respectively, P = 0.93). The RC-PVP group had a higher effective rate during the first week and the first month (93.3% vs. 70.6%, P = 0.02) and at 3 months (90.4% vs. 73.9%, P = 0.03). Long-term follow-up indicated that vertebral recollapse of the same treated vertebral body occurred in 5 patients after conventional PVP, which was not observed in the RC-PVP group.

LIMITATIONS

The small number of included patients and no long-term follow-up.

CONCLUSIONS

RC-PVP, with the destruction of IVC, may lead to better clinical outcomes with fewer complications.