KUMMELL'S DISEASE

Percutaneous short segmental fixation combined with bone cement augmentation for stage III Kümmell's disease without nerve deformity

The objective of this study was to evaluate the safety and efficacy of percutaneous pedicle screw fixation combined with bone cement augmentation in the management of stage III Kümmell disease without nerve deformity. A retrospective analysis was conducted on 17 patients diagnosed with stage III Kümmell disease without nerve deformity, who underwent treatment with percutaneous pedicle screw fixation combined with bone cement augmentation between April 2019 and 2022. Preoperative, postoperative, and final follow-up clinical outcome measures were collected, including Visual Analog Scale scores and Oswestry Disability Index scores. Additionally, lateral radiography was used to measure the Cobb angle and height of the anterior border of the affected vertebral body. Operative time, volume of injected bone cement, intraoperative cement leakage, and other complications were recorded. All patients underwent successful surgery, resulting in significant reductions in Visual Analog Scale scores, Oswestry Disability Index scores, and Cobb angle postoperatively; meanwhile there was a significant increase in height of the anterior border of the affected vertebral body. No major complications occurred during the follow-up period. In conclusion, percutaneous pedicle screw short-segment fixation combined with bone cement augmentation appears to be an effective surgical option for treating stage III Kümmell disease without nerve deformities.

Treatment of Kümmell’s disease following the occurrence of osteoporotic vertebral compression fracture

Background: The incidence of osteoporotic vertebral compression fracture (OVCF) is increasing with the increase in the elderly population. Kümmell’s disease following OVCF occurrence is not a rare complication and is frequently associated with severe pain or neurologic deficit with progressive kyphotic deformity. Kümmell’s disease initially meant post-traumatic delayed vertebral collapse, but now it is also termed nonunion, osteonecrosis, or intravertebral vacuum cleft, all of which suggest the disruption of the healing process.Current Concepts: The major pathogenesis of Kümmell’s disease is a vascular compromise caused by mechanical stress or intravascular pathology. The key radiologic sign to diagnose Kümmell’s disease is the presence of intravertebral vacuum cleft, observed using simple X-ray, computed tomography, or magnetic resonance imaging. Magnetic resonance imaging is the most useful diagnostic tool showing gas or fluid signals. The risk factors for the progression of Kümmell’s disease after OVCF include middle-column injury, confined low signal intensity on T2-weighted image, posterior wall combined fracture, kyphotic angle >10°, and a height loss >15%. Its treatment can be broadly classified as conservative treatment, bone cement injection, and surgical treatment. The appropriate treatment method is selected based on the pain intensity, neurological symptoms, and the severity of the kyphotic deformity.Discussion and Conclusion: Kümmell’s disease usually develops along with osteoporosis. Therefore, the treatment should be focused on relief from symptoms associated with Kümmell’s disease and osteoporosis. It is recommended that an anabolic agent should be administered after the diagnosis of Kümmell’s disease, regardless of the treatment modality.

Clinical Efficacy of Percutaneous Kyphoplasty at the Hyperextension Position for the Treatment of Osteoporotic Kümmell Disease

SUMMARY OF BACKGROUND DATA

Percutaneous kyphoplasty might be effective for osteoporotic Kümmell disease.

OBJECTIVE

To investigate the clinical efficacy of percutaneous kyphoplasty in hyperextension for osteoporotic Kümmell disease.

STUDY DESIGN

Retrospective study.

METHODS

A retrospective analysis was carried out on data from downstream balloon kyphoplasty treatments in hyperextension for 18 patients with osteoporotic Kümmell disease. All cases were single-segment disease affecting T5 (1 case), T7 (1 case), T8 (2 cases), T11 (6 cases), T12 (4 cases), L1 (2 cases), L2 (1 case), or L4 (1 case). Dual-energy x-ray absorptiometry bone mineral density values ranged from -2.8 to -5.8 SD. The sagittal Cobb angle of the involved segment was measured before and after the operation and the final follow-up also included a visual analog pain score (VAS) and the Oswestry Disability Index (ODI) after comprehensive efficacy assessment.

RESULTS

All patients were followed up for 12-36 months, with an average of 15.8 months. Patients showed lower back pain relief and improvement in daily life activities. The kyphosis Cobb angle improved from 32.60±3.82 degrees before surgery to 7.60±1.68 degrees after surgery, and VAS and ODI scores significantly improved from 8.7±0.96 points and 88.6±3.76% to 2.6±0.32 points and 28.6±2.67%, respectively. The last follow-up for the kyphosis Cobb angle yielded a value of 9.60±2.06 degrees, and VAS and ODI averaged 2.2±0.26 points and 26.4±2.46%, respectively. Compared with 2 days postoperatively, the differences were not statistically significant. Intervertebral cement leakage occurred in 1 case, but no symptom was observed and no treatment was performed.

CONCLUSION

Percutaneous balloon kyphoplasty in the hyperextension position is an effective method for osteoporosis in Kümmell disease.

Kümmell's disease, an uncommon and complicated spinal disorder: a review

Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal trauma. The patho physiology, clinical presentation, imaging and treatment options of this disease remain controversial. The most widely accepted hypothetical patho physiology is avascular osteonecrosis. The intravertebral vacuum cleft phenomenon is considered a radiographic sign of avascular osteonecrosis of the vertebral body and is highly suggestive of Kümmell's disease. Treatment options include nonsurgical and surgical treatment, and percutaneous vertebral augmentation. The primary aims of surgical treatment of Kümmell's disease are neural decompression and stabilization of the spinal column. Surgery can involve an anterior, posterior, or combined anterior and posterior approach. Surgery and percutaneous vertebral augmentation provide significant symptomatic relief, functional improvement and deformity correction. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon.