Transpedicular Intrabody Cage Insertion with Posterior Spine Stabilization in Kümmell Disease: Report of 2 Cases.

Abstract

Kümmell disease has been treated with multiple surgical approaches, as described in the literature. However, there are few reports describing the technique of transpedicular intrabody cage insertion to enhance bony fusion and maintain the height of the vertebral body. We describe the technique of transpedicular intrabody cage insertion with posterolateral fusion in patients with Kümmell disease. Two patients diagnosed as having Kümmell disease were treated with transpedicular intrabody cage insertion with allogenic bone graft and posterolateral fusion with pedicle screw insertion. Both patients were followed up routinely at 1 month, 3 months, and 6 months, and clinical evaluations and radiography were performed. Patients 1 and 2 visited our center 8 months and 33 months, respectively. After surgery, we obtained additional radiography and magnetic resonance imaging. Postoperative computed tomography was performed at 3 months. The visual analog scale score for pain and the Cobb angle were evaluated preoperatively and postoperatively. The operation was completed in both patients without any complications. Immediate postoperative radiographs showed the intrabody cage with corrected kyphosis. Postoperative computed tomography scans at 3 months and radiographs and magnetic resonance imaging at 8 months (patient 1) and 33 months (patient 2) showed bone formation of the vertebral body involved with Kümmell disease and maintenance of the vertebral body height in both patients. Back pain was significantly improved in both patients. Transpedicular intrabody cage insertion is a safe and effective procedure for treating vertebral osteonecrosis to achieve bone formation at the site of vertebral osteonecrosis and to maintain body height.