A Comparative Study Of Short-Segment Fixation Plus Augmented And Long-Segment Fixation In The Treatment Of Kümmell Disease Complicated With Spinal Canal Stenosis

Objective: Previous scholars have proposed two methods of long segment fixation and short segment fixation and cement reinforcement for the treatment of Kümmell disease,which can obtain satisfactory results,but there are few articles about which method is better and what is the difference after operation.This study compared the efficacy of bone cement-augmented short-segment fixation(BCASSF)and long-segment fixation(LSF)in the treatment of Kümmell disease complicated with spinal canal stenosis and provide options for clinical treatment.Methods: A retrospective study was conducted on 54 patients with Kümmell disease who met the selection criteria in the Department of Spinal surgery of Xi'an Honghui Hospital from January 2012 to December 2017.21 cases were treated with long-segment fixation(LSF group),and 33 cases were treated with bone cement-augmented short-segment fixation(BCASSF group).There was no significant difference in age,sex,course of disease,body mass index(BMI),bone mineral density(BMD),visual analogue score(VAS)of pain before operation,dysfunction index before operation(ODI),anterior vertebral height(AVH)before operation and kyphosis Cobb angle before operation between the two groups.The operation time,intraoperative blood loss,length of hospital stay,operation cost and operation-related complications were recorded in the two groups,and the operative effect was evaluated by VAS score,ODI score,Frankel neurological function score,AVH and kyphosis Cobb angle changes.Results: All patients completed the operation successfully and were followed up for an average of 14.6 months(12~18).There was no significant difference in operation time between BCASSF group(125.9±10.0min)and LSF group(137.9±6.5min).The intraoperative blood loss in BCASSF group(224.5 ±18.1ml)was lower than that in LSF group(335.9 ±21.5ml)(P<0.05).There was significant difference in the length of hospital stay between BCASSF group and LSF group(7.5±1.6d vs 9.8±2.8d,P<0.05).The operation cost in BCASSF group was lower than that in LSF group(P<0.05).There were 2 cases of asymptomatic bone cement leakage and 1 case of cerebrospinal fluid leakage in BCASSF group,2 cases of cerebrospinal fluid leakage and 2 cases of delayed wound healing in LSF group.There was no significant difference in the incidence of complications between the two groups(P>0.05).VAS score,ODI score,Frankel neurological function score,AVH and Cobb angle were significantly improved in both groups 3 days after operation and at the last follow-up.Except for the VAS score,there was no significant difference in the above data between the two groups at 3 days after operation and at the last follow-up(P>0.05).The VAS score and ODI score of the BCASSF group were better than those of the LSF group at 3 days after operation.The VAS score of the two groups at the last follow-up was also significantly different from that of the 3 days after operation,but there was no significant difference in the VAS score between the two groups at the last follow-up.At the last follow-up,the AVH and Cobb angle in BCASSF group were lower than those in LSF group,but there was no significant difference between the two groups.Conclusion: Two surgical methods can achieve satisfactory results,such as stabilizing the vertebral body,relieving pain,improving the activity of patients and the recovery of neurological function.The LSF group had more intraoperative blood loss,higher hospitalization cost and more fixed segments,which led to the decrease of spinal range of motion.Compared with LSF group,BCASSF group had better early clinical effect(pain relief,functional recovery),and better intraoperative blood loss,hospitalization time and hospitalization cost,but the long-term effects of the two groups need to be further studied and analyzed.