Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
Shaanxi University of Chinese Medicine, Xi'an, China.
Orthop Surg. 2022 Jul;14(7):1533-1540. doi: 10.1111/os.13260. Epub 2022 May 27.
The continuous occurrence of Kummell's disease is extremely rare in clinical practice, and its treatment is difficult. The study aimed to present a rare case of consecutive Kummell's disease combined with Parkinson's disease (PD) and experienced internal fixation failure.
A 69-year-old female patient had a history of PD for 10 years, and was treated by posterior decompression, fixation, and fusion because of Kummell's disease of T12 with neurological damage. The patient's back pain and lower limb pain were significantly improved after surgery. Twenty-two months later, the patient was rehospitalized for Kummell's disease of L4 with neuropathic pain of left lower extremity. She received almost identical surgical procedures as T12 lesion, and the difference was no L4 vertebroplasty preformed due to the fact that the L4 vertebrae collapse was not obvious, the intravertebral vacuum cleft (IVC) range was small, and the pedicle screw fixation strength was high. The pain symptoms were significantly relieved after operation. Unfortunately, there was a complication of internal fixation failure that occurred a month later, and a revision operation was carried out.
Osteoporosis combined with PD may lead patients to become prone to consecutive Kummell's disease, and patients are prone to experience failure of internal fixation. Bone cement filling of vertebral IVC and effective support of anterior vertebral column are very important procedures to ensure the clinical efficacy of treating Kummell's disease.
临床上连续发生的 Kummell 病极为罕见,其治疗困难。本研究旨在报告一例罕见的连续 Kummell 病合并帕金森病(PD)并经历内固定失败的病例。
一名 69 岁女性患者患有 PD 病史 10 年,因 T12 的 Kummell 病合并神经损伤而行后路减压、固定和融合术。术后患者腰背疼痛和下肢疼痛明显改善。22 个月后,患者因左下肢神经性疼痛再次入院治疗 L4 的 Kummell 病。她接受了与 T12 病变几乎相同的手术程序,不同之处在于由于 L4 椎体塌陷不明显、椎体内真空裂隙(IVC)范围小以及椎弓根螺钉固定强度高,因此未行 L4 椎体成形术。术后疼痛症状明显缓解。不幸的是,一个月后发生内固定失败的并发症,并进行了翻修手术。
骨质疏松症合并 PD 可能导致患者易患连续 Kummell 病,且患者易发生内固定失败。椎体内 IVC 的骨水泥填充和前柱的有效支撑是确保治疗 Kummell 病临床疗效的重要步骤。