1. 2021;24;E477-E482Percutaneous Vertebroplasty Using a Rotary Cutter for Treating Kümmell’s Disease with Intravertebral Vacuum Cleft
   Prospective Study
   Min Li, MD, Shuai Li, MD, Xun-wei Liu, MD, Zhen Yang, MD, Gang Min, MD, and Chen Zhong, MD.

BACKGROUND: Reported data indicate that the curative effect of percutaneous vertebroplasty (PVP) on the patients with intravertebral vacuum cleft (IVC) is worse than on those without IVC.

OBJECTIVES: This study was to prospectively investigate the advantage of rotary cutter-PVP (RC-PVP) in patients with Kümmell’s disease with IVC.

STUDY DESIGN: A prospective outcome study.

SETTING: A tertiary care hospital.

METHODS: Patients who underwent conventional PVP served as the control group. For the RC-PVP group, the rotary cutters were applied before the cement injection to destroy the IVC structure and the surrounding necrotic bone. The following data were compared between the two groups: the cement filling patterns, effective therapeutic rate, the pre- to post-procedural changes of spinal geometry, and the subsequent fractures.

RESULTS: This study included a total of 64 patients (30 and 34 patients in RC-PVP group and control group, respectively). In the RC-PVP group, the cement in 26 cases was filled as a mixed pattern, while the filling pattern in the control group was mainly the cystic type (n = 31). There were no significant differences in the height restoration rate between the RC-PVP and control groups (32.7 ± 13.6 and 32.4 ± 13.9, respectively, P = 0.93). The RC-PVP group had a higher effective rate during the first week and the first month (93.3% vs. 70.6%, P = 0.02) and at 3 months (90.4% vs. 73.9%, P = 0.03). Long-term follow-up indicated that vertebral recollapse of the same treated vertebral body occurred in 5 patients after conventional PVP, which was not observed in the RC-PVP group.

LIMITATIONS: The small number of included patients and no long-term follow-up.

CONCLUSIONS: RC-PVP, with the destruction of IVC, may lead to better clinical outcomes with fewer complications.

KEY WORDS: Back pain, bone cements, osteonecrosis, vertebroplasty