Kummell's disease

Kümmell Disease: A Rare Spinal Disorder

Kümmell disease, also known as Kummel's disease or avascular necrosis of a vertebral body, is a rare and complex spinal disorder. It is characterized by the delayed collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after minor trauma.

Key Features:

• Delayed post-traumatic vertebral collapse
• Avascular necrosis of a vertebral body
• Compression deformity, intravertebral vacuum cleft, and exaggerated kyphosis weeks to months after a minor traumatic injury
• Painful progressive angular kyphosis as a result of delayed vertebral body collapse

Causes and Risk Factors:

• Minor spinal trauma
• Avascular necrosis of the vertebral body (most supported etiopathogenetic hypothesis)
• History of trauma with a negative x-ray, followed by worsening clinical symptoms

Incidence and Predictors:

• Incidence remains unclear
• Predictors of Kümmell disease are still under investigation

Treatment Approaches:

• Comprehensive review of treatment approaches is needed due to the rarity of the condition
• Treatment may involve addressing the underlying cause, managing pain and kyphosis, and preventing further complications.

References:

[1] Kummel's disease manifests as a delayed collapse of a vertebral body, post-trauma. This condition was first noted by the German physician Hermann Kummell in 1891. [3] [2] Kümmell disease is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. [4] [3] Kummel's disease is a crush fracture of a vertebral body caused by a minor trauma, with the most accepted etiology being avascular necrosis. [8] [5] Kümmell's disease presents as vertebral osteonecrosis typically affecting a thoracic vertebra with compression deformity, intravertebral vacuum cleft, and exaggerated kyphosis weeks to months after a minor traumatic injury. [13] [6] Kummel's disease is defined as a clinical condition in which patients develop a painful progressive angular kyphosis as a result of a delayed vertebral body collapse after a minor spinal trauma. [14]

Kummell's disease, also known as delayed posttraumatic vertebral collapse or avascular necrosis of the vertebrae, presents with a range of signs and symptoms.

Initial Stage

• The first stage is often characterized by minor symptoms and no limitation in activity [2].
• Patients may experience a brief period of relative well-being before the onset of more severe symptoms [2].

Progressive Symptoms

• As the disease progresses, patients may develop chronic pain that continuously increases [14].
• Pain is often accompanied by progressive angular kyphosis (a forward leaning posture) due to vertebral body collapse [7][6].
• Some patients may experience neurological symptoms such as numbness or weakness, although this is not a universal symptom [9].

Diagnostic Features

• One of the most characteristic features of Kummell's disease is delayed healing or nonhealing due to osteonecrosis (death) of fractured vertebrae and loss of bone density [13][10].
• Vertebral kyphosis and intravertebral instability are often present when the disease is diagnosed [6].

Other Features

• Patients with Kummell's disease may have a history of trivial trauma, axial pain, and vertebral body collapse [8].
• The disease can be asymptomatic for an extended period before symptoms become apparent [15].

It is essential to note that these signs and symptoms can vary in severity and presentation among individuals. A comprehensive diagnosis by a medical professional is necessary for accurate identification and treatment of Kummell's disease.

References: [2] - Steel in 1951 divided the clinical course of KD into five stages. [6] - The presence of vertebral kyphosis and intravertebral instability when diagnosed. [7] - Kümmell disease (KD) is defined as a clinical condition in which patients develop a painful progressive angular kyphosis... [9] - Some patients with Kummel disease have pain and neurological symptoms, such as numbness or weakness. [10] - One of the most characteristic features of KD is delayed healing or nonhealing due to osteonecrosis of fractured vertebrae... [13] - Delayed healing or nonhealing due to osteonecrosis of fractured vertebrae and loss of bone density. [14] - The main symptom of KD is the chronic pain, which continuously increases. [15] - Initially, it usually has normal radiological tests and an asymptomatic period...

Kummell's disease, also known as vertebral body collapse or Kümmell disease, can be diagnosed through various imaging tests and clinical evaluations.

• Serial Imaging: The best testing for Kummell's disease is serial imaging, which involves taking multiple images over time to show the progression of the condition. This can help demonstrate an initially intact vertebral body after trauma, followed by collapse as the patient becomes symptomatic [1].
• Plain Radiographs: Delayed compression deformity of the affected vertebral body and exaggerated thoracic kyphosis can be demonstrated on plain radiographs, CT, or MRI [2]. However, these tests may not always show evidence of a fracture initially.
• Computed Tomography (CT): CT scans can help identify delayed vertebral collapse with an intravertebral cleft (IVC) in Kummell's disease [8].
• Magnetic Resonance Imaging (MRI): MRI is the most useful diagnostic tool for the diagnosis of vertebral compression fracture and IVC, especially T1-weighted images and fat-suppressed sequences [5]. This can help identify ischemia and non-union of the anterior vertebral body wedge.
• Vertebral Biopsy: In some cases, a vertebral biopsy may be necessary to confirm the definitive diagnosis of Kummell's disease [4].

It is essential to consider the clinical presentation, radiographic findings, and dynamic mobility when diagnosing Kummell's disease. Vascular causes should also be considered in the differential diagnosis.

References: [1] C Matzaroglou (2014) - The best testing is serial imaging... [2] LT Nickell (2013) - Delayed compression deformity of the affected vertebral body... [5] J Lim (2017) - MRI is the most useful diagnostic tool for the diagnosis of vertebral compression fracture and IVC... [8] W Xu (2022) - All cases were examined by X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). [4] I Bolívar-Roldán (2022) - After imaging tests and biopsy, the definitive diagnosis of Kummell's disease was reached.

Treatment Goals and Options for Kummell's Disease

Kummell's disease, also known as osteoporotic vertebral collapse or Kummel disease, is a condition characterized by the collapse of one or more vertebrae due to osteoporosis. The treatment goals for this condition focus on stabilizing the bone fracture, promoting fracture healing, restoring vertebral body height, and alleviating pain.

Conservative Treatment

Conservative treatment options for Kummell's disease include:

• Bed rest
• Wearing a brace
• Lumbar traction
• Analgesics to manage pain
• Medication to prevent osteoporosis

These measures can help alleviate symptoms and stabilize the affected vertebrae, but they may not be sufficient to treat more severe cases of Kummell's disease.

Minimally Invasive Treatments

Minimally invasive treatments for Kummell's disease include:

• Percutaneous vertebroplasty (PVP)
• Balloon kyphoplasty (PKP)

These procedures involve injecting bone cement into the affected vertebra to stabilize it and alleviate pain. PVP is a more recent development that has been shown to be effective in treating Kummell's disease.

Surgical Treatment

Surgical treatment options for Kummell's disease include:

• Open anterior and posterior surgery
• Minimally invasive PVP or PKP

The choice of surgical treatment depends on the severity of the condition, patient factors, and surgeon preference. Surgical treatment can provide more effective stabilization and pain relief than conservative treatment.

Sequential Infusion in Unipedicular PVP

A study has shown that sequential infusion in unipedicular PVP is a safe and effective procedure for neurologically intact Kummell's disease [8]. This approach involves injecting bone cement into the affected vertebra through a single puncture site, with multiple injections performed to achieve optimal stabilization.

Treatment Goals and Outcomes

The treatment goals for Kummell's disease include stabilizing the bone fracture, promoting fracture healing, restoring vertebral body height, and alleviating pain. Treatment outcomes can vary depending on the severity of the condition, patient factors, and the chosen treatment approach [3][5].

References:

[1] by P Kim · 2016 · Cited by 32 — The purpose of this study was to evaluate the efficacy of balloon kyphoplasty for treating Kummel disease accompanying severe osteoporosis. [2] by P Kim · 2016 · Cited by 32 — Although balloon kyphoplasty for treating Kummell disease is known to provide stabilization and pain relief, it may be associated with the development of ... [3] by B Mao · 2024 — Treatment goals in Kummell's disease focus on stabilizing bone fracture, promoting fracture healing, restoring vertebral body height, and ... [5] by S Dai · 2021 · Cited by 31 — The treatment of KD mainly includes conservative treatment, minimally invasive PVP or PKP and open reduction internal fixation [15]. Most of KD ...

Kümmell's disease, also known as delayed post-traumatic osteonecrosis of the vertebral body, can be challenging to diagnose due to its rarity and non-specific symptoms. However, there are several conditions that should be considered in the differential diagnosis of Kümmell's disease.

Conditions to Consider:

• Avascular necrosis of the vertebral body: This is a condition where the blood supply to the vertebral body is disrupted, leading to bone death.
• Infection: Vertebral osteomyelitis or discitis can cause similar symptoms to Kümmell's disease.
• Malignancy: Metastatic lesions or primary tumors in the spine can lead to vertebral collapse and pain.
• Trauma: Other types of vertebral fractures, such as compression or burst fractures, should be ruled out.

Key Diagnostic Features:

• Delayed onset of symptoms (usually 2 weeks after trauma)
• Vertebral body collapse
• Ischemia and non-union of the anterior vertebral body wedge fracture
• Absence of an intervertebral cleft does not exclude avascular necrosis from the differential diagnosis

Diagnostic Imaging:

• MRI may be useful to establish the diagnosis of Kümmell's disease, as it can help rule out other causes of vertebral collapse.
• Careful review of imaging and exclusion of other common causes of vertebral body collapse on radiology is vital to avoid missing the diagnosis.

References:

[1] Chow R, Shen FH. Kummell's disease delayed post-traumatic osteonecrosis of the vertebral body. Eur Spine J. 2010. [6] by C Matzaroglou · 2014 · Cited by 70 — The three major causes of vertebral body collapse include infection, malignant neoplasia, and trauma and it may be difficult to distinguish between them, ... [10] There is no diagnostic imaging for the disease and the diagnosis remains “a diagnosis of exclusion”; however, careful review of imaging and exclusion of other common cause of vertebral body collapse on radiology is vital to avoid missing the diagnosis. ... Swartz K, Fee D. Kummell's disease: A case report and literature review. Spine (Phila ... [12] Kόmmell’s disease (KD) is a rare clinical entity and includes patients, who after a trivial trauma and an asymptomatic period, develop a progressive vertebral body collapse and a painful kyphosis. [13] Kümmell's disease (KD) is a rare clinical entity and includes patients, who after a trivial trauma and an asymptomatic period, develop a progressive vertebral body collapse and a painful kyphosis. The main pathologic eliciting event still remains unclear. Vertebral body collapse can be the result of infection, malignant neoplasia or trauma.

Note: Kümmell's disease is a rare condition, and its diagnosis may require a combination of clinical evaluation, imaging studies, and laboratory tests to rule out other potential causes of vertebral body collapse.