Background: Kümmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD.
Objective: We aimed to explore whether percutaneous kyphoplasty can alleviate pain distal to the fracture area caused by either Stage I or Stage II KD.
Study design: A retrospective study.
Setting: This study was conducted at a university-affiliated hospital.
Methods: We conducted a retrospective analysis on patients with Stage I or Stage II KD who underwent surgical treatment in our hospital from December 2021 through October 2023. All patients were accompanied by pain distal to the fracture area (i.e., pain in the rib region or the distal lumbosacral region). All patients underwent percutaneous kyphoplasty. Postoperative follow-up thoracic or lumbar x-rays confirmed polymethylmethacrylate diffusion and vertebral reduction. Pain distal to the fracture area and functional impairment were evaluated at presurgery and at postsurgery one day, one week, and one month. In addition, the anterior, middle, and posterior vertebral heights and the Cobb angle were measured at pre- and postsurgery.
Results: A total of 42 patients were enrolled; 39 (92.9%) were women. Their average age was 73.48 ± 8.81 years. The fracture segments with KD and pain distal to the fracture area were as follows: T7 (9 cases, 21.4%); T10 (9 cases, 21.4%); and T8 (8 cases, 19.0%). The common location of pain distal to the fracture area was the rib region (30 cases, 71.4%). The preoperative Visual Analog Scale score of pain distal to the fracture area and the Oswestry Disability Index scores were significantly higher than those at postsurgery one day, one week, and one month. The heights of the anterior, middle, and posterior edges of the vertebrae on x-ray were significantly higher postoperatively than preoperatively. The Cobb angle of the fractured vertebrae was also higher postoperatively than preoperatively.
Limitations: Our study was conducted at a single center; single-center studies may introduce bias. Our study also had a relatively short follow-up time.
Conclusion: Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty.
Keywords: Kümmell disease; pain distal to the fracture area; Percutaneous kyphoplasty.