• Yazhou Lin, Zhe Chen, Qiang Zhang, Jianru Qiu, Xingkai Zhang, Peng Cao, Wenjian Wu, and Yu Liang.
• Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000, China.
• Eur Spine J. 2024 Dec 1; 33 (12): 448844984488-4498.

PurposeTo evaluate the clinical efficacy of surgery in Kummell's disease (KD) to help us select the optimum surgical strategy.MethodsWe included 67 KD patients who underwent Percutaneous vertebral plasty (PVP), Percutaneous kyphosis plasty (PKP), Percutaneous pedicle screw fixation (PPSF) or Posterior decompression osteotomy fixation (PDOF). The differences in imaging parameters and prognosis changes of pre-operation, post-operative and follow-up endpoint were analyzed.ResultsThe incidence rate of KD was 10.02% (67/668) in vertebral compressibility fracture. 80.60% of patients underwent PVP/PKP, 14.93% underwent PPSF, and 4.47% underwent PDOF. The significant differences between the actual used surgical methods and the classification recommended surgical strategies could be found. In I type, there was no significant difference in total improvement of the radiography data and clinical efficacy between PVP and PKP. In II type, there was a significant correlation between opening and closing sign (OCS) and surgical choice. Compared with PPSF, the positive OCS patients who underwent PVP/PKP suffered a poor prognosis. PDOF is an effective surgical method for type III, but PVP could also achieve a good prognosis for patients with poor condition.ConclusionThe mainstream KD classification system has shortcomings, and completely following its treatment strategy may lead to poor prognosis. Compared to PKP, PVP is a better choice for type I patients. OCS is one of the important factors in surgical selection for type II patients. The Li's type III is mainly treated with PDOF but the overall condition of the body needs to be evaluated.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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