Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review

Abstract

Objective: This study aimed to conduct a systematic review of literature comparing the clinical effectivenessand safety between anterior reconstruction (AR) and posterior osteotomy (PO) in the treatmentof Kümmell's disease with neurological deficits.Methods: We systematically reviewed the literature in PubMed, EMBASE, Cochrane Database of SystematicReviews, and the Web of Science for “spin*,” “surg*,” “Kümmell's disease,” “Kummell's disease,”“Kummell disease,” “vertebral osteonecrosis,” “vertebral pseudarthrosis,” “intravertebral vacuum cleft,”“delayed vertebral collapse,” and “compression fracture nonunion”. Quality was assessed using theGrading of Recommendations, Assessment, Development, and Evaluation method.Results: A total of 10 publications involving 268 Kümmell's disease patients with neurological deficitswere included in this review, with 7 studies of low- or very low-quality. There were 37.7% and 62.3% ofpatients receiving AR and PO, respectively. For clinical outcomes, AR group showed no significant differencesin pain, neurological dysfunction, and imaging outcome improvements compared with patientswho underwent PO. However, the incidence of implant-related complications including loose screw,screw fracture, screw disconnection, and plate dislodgment, was higher in AR group compared with POgroup (21.6% vs. 14.3%). As another major complication, AR group more often required a second surgery.Conclusion: This systematic review demonstrated that both AR and PO could improve pain, neurologicaldysfunction and imaging outcomes. However, serious comorbidities, multilevel corpectomies and/orsevere osteoporosis highly required PO. Design discrepancies were found in the current studies, furtherhigher-quality studies are warranted.