Percutaneous Pedicle Screw Fixation with Bone Cement Augmentation Under Epidural Anesthesia for Treatment of Kümmell Disease in Extremely Old Age.

Abstract

In cases of Kümmell disease without neurologic deficit, percutaneous vertebroplasty or kyphoplasty has achieved short-term favorable outcomes. In the long term, recollapse of the augmented vertebral body and aggravation of kyphosis at the index level is often reported. Owing to medical comorbidities, elderly patients are often unsuited for extensive open spine surgery under general anesthesia. A 95-year-old man presented with a 1-month history of intractable back pain and gait disturbance. Magnetic resonance imaging revealed intravertebral avascular necrosis with fluid collection at the L4 vertebra. After postural reduction using a pillow in the supine position for 2 days, percutaneous pedicle screw fixation with bone cement augmentation was performed at the L3-5 level including L4 fracture under epidural anesthesia. Additional posterior column compression was performed to achieve restoration of spinal canal and lumbar lordosis. Severe back pain was reduced after surgery, and the patient was able to walk the day after surgery. To our knowledge, this is the first case of Kümmell disease in an extremely elderly patient in whom good clinical result was obtained after postural reduction, vertebral augmentation, and short segment percutaneous pedicle screw fixation under epidural anesthesia.