Treatment Of Type ? Kumell Disease By Unilateral Pedicle Vertebral Subtotal Resection

Objective:To investigate the efficacy of unilateral pedicle vertebral subtotal resection in the treatment of type ? Kummell disease and evaluate the clinical application of this method.Methods:A retrospective analysis of 10 cases of type ? Kummell disease from January 2015 to March 2017 in our hospital,including 3 males and 7 females,with an average age of 67.80 ± 4.47 years old(61-76 years).The 10 patients were all 1 vertebral lesions.The location of lesions was 2 cases of T11,5 cases of T12,and L1 of 3 cases.All patients underwent unilateral pedicle vertebral subtotal resection.The clinical efficacy was evaluated with surgery,kyphosis,SVA,VAS,ODI,ASIA classification and surgical complications.Results:The average angular kyphosis angle of the group was 37.6±5.66°(31°-49°)before operation,and the preoperative SVA average was 13.1 ± 3.77cm(9.2cm-19.6cm),the preoperative VAS score was 7.5 ± 1.08(6-9),and the preoperative ODI score was 58.5± 11.1%(43.20%-73.80%).The preoperative nervous system function evaluation used ASIA method,3 ASIA E grade,4 ASIA D grade,3 ASIA C grade.The average follow-up time after operation was 23 ± 10 months(13-33 months).All patients were operated smoothly,and no neurological damage was aggravated during and after operation.The average operation time was 170 ± 23.57Min(140Min-210Min),and the mean intraoperative bleeding amount was 1020±204.4ml(800ML-1400ML).The average angular kyphosis angle of the patients was 2.4±3.03°(-2°-8°),and the average angular kyphosis angle was 8.1±2.92°(5°-15°)at the last follow-up,The difference was statistically significant compared with the mean angular kyphosis angle before the operation.The last follow-up SVA was 4.89±1.96cm(2.5cm-7.8cm),and the average correction of 8.21cm was statistically significant.The VAS score of the last follow-up was 1.3±0.949(0-3),compared with the preoperative improvement of 6.2 points,the difference was statistically significant;the last follow-up ODI score was 20.12%±8.19%(7.20%-36.00%),The ODI score of the last follow-up was improved by 65.61%compared with the pre-operation ODI score;The ASIA grade in 6 patients after the operation was 1 higher than that before the operation,and 1 patient was still D before and after the operation,and 3 patients were E before and after the operation.Postoperative complications such as bone cement leakage,cerebrospinal fluid leakage,nerve function deterioration and internal fixation loosening were not occurred in all patients,1 cases of superficial incision infection and 1 cases of pulmonary infection.Conclusion:The treatment of type III Kummell disease by unilateral pedicle vertebral subtotal resection can effectively remove the vertebrae and obtain complete decompression ahead of the spinal canal.Due to the preservation of the ligaments of one side of the pedicle,small joints,laminae and spinous processes,the surgical method can obtain better stability after the operation and facilitate the interbody fusion and promote the interbody fusion.Functional recovery of the patient.