Pediculoplasty combined with vertebroplasty for the treatment of Kummell's disease without neurological impairment: robot-assisted and fluoroscopy-guided.

With the development of radiology and minimally invasive technology, vertebroplasty has become the mainstream treatment for Kummell's disease. However, the catastrophic complication of bone cement displacement appears occasionally. We use robot-assisted pediculoplasty combined with vertebroplasty to avoid such complications. From January 2015 to January 2018, 87 patients suffering from thoracolumbar Kummell's disease without neurological symptoms were treated by robot-assisted pediculoplasty combined with vertebroplasty. Pediculoplasty as a "bridge" allows the bone cement at the anterior edge of the vertebral body to be fixed in the vertebral body through the intrapedicular cement, which can effectively prevent bone cement displacement. The clinical efficacy was evaluated based on the statistical analysis results of vertebral body index (VBI), Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) at 3, 6, 12, 18, and 24 months after treatment. The average operation time was 85.23±10.48 min, and the average volume of cement injected was 4.97±0.66 ml. The patients' preoperative VBI, Cobb angle, VAS and ODI scores were 62.01±11.32, 33.78±11.99°, 7.47±0.82, and 78.37±7.14, respectively. The postoperative measurements were 87.06±4.45, 16.57±6.46°, 2.89±0.95, and 46.91±8.44. At the last follow-up, the outcomes were 86.82±4.27, 16.72±6.22°, 1.75±0.69, and 20.48±4.48, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). The four evaluation indexes improved by 65.3%, 50.5%, 76.6%, and 73.9%, respectively. This 2-year follow-up study shows robot-assisted and fluoroscopy-guided pediculoplasty combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell's disease without neurological impairment. This technique effectively prevents cement displacement and achieves rapid pain relief, with satisfactory vertebral body height restoration, and kyphotic deformity improvement.