Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kummell's disease: a systematic review and meta-analysis

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kummell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kummell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle ( LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I-2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I-2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I-2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85 degrees, 95% CI (-5.10, 3.40), I-2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kummell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.

Automated summary

A systematic review comparing the clinical and radiological outcomes of vertebral augmentation + short-segment fixation (VA + SSF) versus VA alone in Kummell's disease found no significant difference in pain and functional recovery between the two groups, but suggested that VA + SSF may provide superior long-term results.