Spinal Canal Decompression for Stage III Kummell’s Disease With “Compressing the Posterior Wall of the Vertebral Body” Guided by Intraoperative Ultrasonography - a Preliminary Clinical Study

Abstract Background: There is a lot of controversy regarding the treatment of patients with stage III Kummell’s disease (KD). The purpose of this study is to determine feasibility, efficacy and safety of spinal canal decompression via “compressing the posterior wall of the vertebral body”, guided by real time intraoperative ultrasonography guidance for patients with stage III KD.Methods: We conducted a retrospective study of 11 patients with stage III KD associated with neurological deficits who underwent surgical treatment in The Second Hospital, Cheeloo College of Medicine, Shandong University, from September 2017 to January 2019. All patients underwent spinal canal decompression using a special L-shaped compressor (angular compressor) guided by real time ultrasonography to squeeze and compress the posterior wall of vertebral body, supplemented by internal fixation and posterior fusion. The primary goal was to determine feasibility, safety and efficacy. Therefore, operating time, Intraoperative blood loss, complications and JOA score, local Cobb angle, ODI score of pre- and post-operative were evaluated.Results: 11 patients (4 males and 7 females) with an average age of 70.2±3.2 years (63-76 years) were included in the study. Mean follow-up period was 17.4 months (12-24 months). Mean operating time was 151±18 min and mean intraoperative blood loss was 202±40ml. Before and after surgery, the local Cobb angle (34.3 °±5.4 °, 11.0 °±4.6 °, respectively), JOA score (12.8±2.1, 22.1±1.9, respectively) and ODI scores (71.4±6.4, 25.5±5.2, respectively) significantly improved (P <0.05). As a complication, one patient developed CSF leakage after surgery, while in another case transient MEP signal change occurred intraoperatively without neurological deficit after surgery.Conclusion: Spinal canal decompression by tamping the retropulsed vertebral body anteriorly, guided by intraoperative ultrasonography can effectively relieve neural compression, significantly shorten operation time, reduce intraoperative blood loss, and have fewer complications for patients with stage III KD, compared with previously reported data. In our opinion, it therefore represents a low risk, minimally invasive, yet effective treatment strategy in this selected group of patients.Trial registration: This study was retrospectively registered in Chinese Clinical Trial Registry.Unique Identifying number: ChiCTR2000040490.