Application of Titanium Alloy 3D-Printed Artificial Vertebral Body for Stage III Kümmell's Disease Complicated by Neurological Deficits

Chunke Dong, Hongyu Wei, Yuting Zhu, Jun Zhou, Haoning Ma, Chunke Dong, Hongyu Wei, Yuting Zhu, Jun Zhou, Haoning Ma

Abstract

Purpose: The current study aimed to compare the clinical and radiographic results of the 3D-printed artificial vertebral body (3DP-AVB) and titanium mesh cage (TMC) for the treatment of Kümmell's disease (KD) complicated by neurological deficits.

Patients and methods: From January 2014 to July 2018, 28 consecutive patients diagnosed with KD and nerve injuries in our department were treated by posterior vertebral column resection and internal fixation. The patients were divided into two groups (3DP-AVB group and TMC group) based on the different anterior column reconstruction implants. Clinical and radiographic parameters were used to evaluate the outcomes.

Results: The two groups achieved excellent clinical and radiographic results 1 month after surgery with no significant difference (P>0.05), while 3DP-AVB group showed better outcomes compared with TMC group during the follow-up after 6 months (P<0.05). The risk of subsidence in 3DP-AVB group was lower than that in TMC group (41.6% vs 87.5%, P<0.05), and severe subsidence (≥5 mm) was correlated with the recurrence of back pain and bad daily life function. No significant difference was found in the improvement of neurological function between the two groups (P>0.05). The blood loss and operation time in 3DP-AVB group were significantly less than both in TMC group (P<0.05).

Conclusion: The lower incidence of cage subsidence, with a better long-term efficacy in maintaining the height of the fused segment, relieving back pain, and improving daily life function indicates that the 3DP-AVB may be a superior alternative for KD with neurological deficits.

Keywords: 3D printing; Kümmell’s disease; artificial vertebral body; neurological deficits; spinal reconstruction; vertebral column resection.

Conflict of interest statement

The authors declare that there are no conflicts of interest in this work.

© 2020 Dong et al.

Figures

Figure 1
Figure 1
3D-printed artificial vertebral body: oblique (A), lateral (B), and superior (C) views.
Figure 2
Figure 2
Measuring method of local kyphotic angle (LKA), anterior vertebral height (AVH), and posterior vertebral height (PVH).
Figure 3
Figure 3
Clinical and radiographic outcomes. (A–E) *P<0.05 compared with the preoperative data. (A–C) †P>0.05 compared with the 1-month postoperative data, ‡P<0.05 compared with the 1-month postoperative data, §P>0.05 compared with the 6-month postoperative data. (D) †P>0.05 compared with the 1-month postoperative data; ‡P>0.05 compared with the 6-month postoperative data. (E) †P<0.05 compared with the 1-month postoperative data.
Figure 4
Figure 4
An 82-year-old female patient experienced Kümmell’s disease complicated by neurological deficits and used a 3D-printed artificial vertebral body (3DP-AVB). (A) T11 collapsed fracture was shown in preoperative X-rays. (B and C) Coronal and sagittal CT showed an intravertebral cleft (IVC) (white triangle). (D–F) MRI showed a decreased signal in IVC (white triangle). (G) Intraoperative images. (H and I) Immediate postoperative X-rays showed that a 3DP-AVB was implanted. (J) Postoperative sagittal T2-weighted MRI showed a sufficient spinal cord decompression. (K and L) Coronal and sagittal CT showed that no subsidence occurred at the final follow-up.
Figure 5
Figure 5
The 3D-printed artificial vertebral body (3DP-AVB) was used in a 75-year-old female patient with stage III Kümmell’s disease. (A) Preoperative X-rays showed T12 collapsed fracture and thoracolumbar kyphosis. (B and C) An intravertebral cleft sign (white triangle) was shown in preoperative CT scans. (D–G) Postoperative and final follow-up plain radiographs showed no cage subsidence and kyphosis recurrence.
Figure 6
Figure 6
A titanium mesh cage (TMC) for stage III Kümmell’s disease. (A and B) Preoperative radiographs and CT scans revealed collapsed fracture and kyphosis at L1 with an intravertebral cleft (IVC) sign (white triangle). (C–E) Preoperative MRI showed a decreased signal of IVC (white triangle). (F) No subsidence in immediate postoperative plain radiographs. (G and H) Final follow-up CT scans showed kyphosis recurrence with TMC subsidence (white triangle).

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