Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review

Abstract

Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.

Keywords: Conservative treatment; Osteonecrosis; Osteoporosis; Surgical procedures, operative; Vertebral body.

FIGURE 1. Radiologic examples about KD.

(A) There is an acute fracture in L1 vertebral body on initial X-ray. In 3 months later, progressive kyphosis of L1 body showed in standing lateral image, and intravertebral cleft (IVC, indicated by white arrow) revealed by extension X-ray. (B) CT shows a clear image about flatter margin of the IVC (indicated by black arrow). TIWI, T2WI, and FS-T2WI show cystic IVC (indicated by black arrow), and there is a prevertebral soft tissue change (indicated by white arrow) related to IVC. KD: Kummell’s disease, IVC: intravertebral vacuum cleft, CT: computed tomography, T1WI: T1 weight image, T2WI: T2 weight image, FS-T2WI: fat-suppressed T2 weight image.