Decreases in fluid shear stress due to microcracks: A possible primary pathogenesis of Kümmell’s disease

Li, Hao; Liang, Chengzhen; Shen, Chengchun; Chen, Qixin

doi:10.1016/j.mehy.2011.08.005

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…However, as China enters an aging society with the explosion of the elderly population and advancement of imaging diagnostic technology, particularly the popularity of MRI has increased the reports of Kümmell's disease. 25 The main symptoms of Kümmell's disease are back pain with or without spinal cord injury. 26,27 The disease progresses progressively, and due to the obvious vertebral body necrosis and collapse, it can lead to severe kyphotic deformity in the late stage, which has a higher incidence of nerve injury than common OVCF.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Han

Chen

et al. 2019

Frontiers of Nursing

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Objective To compare the clinical efficacy between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of Kümmell’s disease in Chinese patients. Methods The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell’s disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM (from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell’s disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis. Results Through comparison, Cobb angle (95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index (ODI) (95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group (95% CI [−1.27, −0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group (95% CI [−13.48, −7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale (VAS) score (95% CI [−0.04, 0.27), P = 0.15), cement volume (95% CI [−0.82, 0.32], P = 0.39) and cement leakage (95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures. Conclusions At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell’s disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results (e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.

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Section: Discussionmentioning

confidence: 99%

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Han

Chen

et al. 2019

Frontiers of Nursing

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“…In clinical practice, it has been found that KD occurs most commonly at the thoracolumbar junction, which is also the common location for osteoporotic vertebral fractures. From a biomechanical perspective, one important reason for the development of KD from vertebral microfractures is that the shear stress in the thoracolumbar segment changes after a large range of motion ( Li et al, 2011 ). Following vertebral fracture, the vertebral morphology changes, mainly characterized by loss of vertebral height and spinal kyphosis ( Röllinghoff et al, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

Feng

Zhang

et al. 2023

Front. Bioeng. Biotechnol.

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Background and objective: Treatment of Kümmel’s Disease (KD) with pure percutaneous kyphoplasty carries a greater likelihood of bone cement displacement due to hardened bone and defect of the peripheral cortex. In this study, we designed a novel minimally invasive pedicle bone cement screw and evaluate the effectiveness and safety of this modified surgical instruments in porcine vertebrae.Methods: 18 mature porcine spine specimens were obtained and soaked in 10% formaldehyde solution for 24 h. 0.5000 mmol/L EDTA-Na2 solution was used to develop in vitro osteoporosis models of porcine vertebrae. They were all made with the bone deficiency at the anterior edge of L1. These specimens were randomly divided into 3 groups for different ways of treatment: Group A: pure percutaneous kyphoplasty (PKP) group; Group B: unilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group; Group C: bilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group. The MTS multi-degree of freedom simulation test system was used for biomechanical tests, including axial loading of 500 N pressure, range of motion (ROM) in flexion, extension, left/right lateral bending, and left/right axial rotation at 5 Nm, and the displacement of bone cement mass at maximum angles of 5° and 10°.Result: The three groups were well filled with bone cement, no leakage or displacement of bone cement was observed, and the height of the vertebrae was higher than pre-operation (p < 0.05). In the left/right axial rotation, the specimens were still significantly different (p < 0.05) from the intact specimens in terms of ROM after PKP. In other directions, ROM of all group had no significant difference (p < 0.05) and was close to the intact vertebrae. Compared with PKP group, the relative displacement of bone cement in groups B and C was smaller (p < 0.05).Conclusion: In the in vitro animal vertebral models, the treatment of KD with the placement of novel pedicle minimally invasive bone cement screw combined with PKP can effectively restore the vertebral height, improve the stability of the affected vertebra and prevent the displacement of bone cement. Biomechanically, there is no significant difference between bilateral and unilateral fixation.

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“…Although many theories have been proposed to explain KD, the pathogenesis is not yet clearly understood. 22) Since intravertebral vacuum cleft (IVC), considered as avascular osteonecrosis, is common in radiologic findings of KD, many authors have cited avascular necrosis of the vertebral body as the primary pathogenesis of KD. 16 25 37)…”

Section: Pathogenesismentioning

confidence: 99%

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

Lee

2023

Korean J Neurotrauma

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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.

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Decreases in fluid shear stress due to microcracks: A possible primary pathogenesis of Kümmell’s disease

Cited by 8 publications

References 32 publications

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

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

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