Is fixation beneficial in Kümmell's disease? A metaanalysis of clinical and radiological outcomes

The standard surgical management of Kummell's disease consists of kyphosis reduction and augmentation of the affected vertebrae. This can be achieved by vertebral augmentation alone or vertebral augmentation in addition to instrumentation. This meta-analysis was conducted to compare vertebral augmentation alone or vertebral augmentation in addition to instrumentation in terms of post-operative complications, improvement in radiographic parameters, and patient-reported outcomes in Kummell's disease. PubMed, Cochrane, and Google Scholar (page 1–20) were searched till August 2024. The studied outcomes were the complications, intra-operative bleeding, operating time, anterior vertebral height, kyphotic Cobb angle and the improvement in back pain with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Four studies were included in this meta-analysis. Operative time and Intra-operative bleeding were significantly higher in vertebral augmentation with fixation (p < 0.00001). No difference was seen in the remaining outcomes between both surgeries. Vertebral augmentation, either in combination with fixation or as a standalone procedure, has demonstrated remarkable efficacy in treating Kummell's disease. Both approaches have shown comparable rates of complications, achieved similar radiographic outcomes, and effectively reduced post-operative pain. However, it is important to note that vertebral augmentation combined with instrumentation and fixation does come with some drawbacks, as it requires more operative time and is associated with higher blood loss.