Expert’s comment concerning Grand Rounds case entitled “Kümmell’s disease: delayed post-traumatic osteonecrosis of the vertebral body” (by R. Ma, R. Chow, F. H. Shen)

Laredo, Jean‐Denis

doi:10.1007/s00586-009-1204-5

Cited by 25 publications

(27 citation statements)

References 7 publications

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“…Kümmell disease is an uncommon condition, occurring in adults older than 50 years, and mostly in women. The thoracolumbar junction, particularly the T12 vertebra, is the most commonly affected vertebral segment [ 6 , 27 ]. Tsujio reported that the incidence of nonunion was 13.5% after 6 months of conventional conservative treatment and revealed a series of significant risk factors for nonunion, including the presence of a vertebral fracture in the thoracolumbar spine, presence of a middle-column injury, and a confined high-intensity or a diffuse low-intensity area in the fractured vertebrae on T2-weighted MR images [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Huang

Feng

et al. 2018

Med Sci Monit

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BackgroundThis study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease.Material/MethodsFrom June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification.ResultsThe VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient.ConclusionsBone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.

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Section: Discussionmentioning

confidence: 99%

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Huang

Feng

et al. 2018

Med Sci Monit

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“…A previous study hypothesized that the osteolysis rate among patients with Kümmell's disease is greater than the rate of bone callus formation. 25 Following PVP or PKP, accelerated osteolysis occurs and may displace the bone cement. 26 27 No cement dislodgement was observed in our study, maybe it was related to regular usage of the antiosteoporotic drug postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell’s disease

Zhang

Gao

Chen

et al. 2015

IJOO

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Background:Post traumatic osteonecrosis of a vertebral body occurring in a delayed fashion was first described by the German doctor Kümmell in 1895. Several studies have reported percutaneous vertebroplasty (PVP), or percutaneous kyphoplasty (PKP) for Kümmell's disease achieves good outcomes. However, it is unknown whether a technique is superior for the treatment of this disease. The objective of the study is to compare the efficacy of PVP and PKP for the treatment of Kümmell's disease.Materials and Methods:A retrospective review was conducted for 73 patients with Kümmell's disease. PVP was performed in 38 patients and PKP in 35 patients. Visual analogue score (VAS) was used to evaluate pain. The anterior vertebral height was measured. The operative time, the incidence of cement leakage and the costs were recorded.Results:In both PVP group and PKP group, the VAS and anterior vertebral height significantly improved at 1-day postoperatively (P < 0.05), and the improvement sustained at the final followup (P > 0.05). Between the PVP and PKP groups, there were no significant differences in VAS and the anterior vertebral height at 1-day postoperatively and at the final followup (P > 0.05). The operating time and expense in the PKP group were higher than the PVP group (P < 0.001). Cement leakages in the PKP group were fewer than PVP group (P < 0.05).Conclusions:PVP is a faster, less expensive option that still provides a comparable pain relief and restoration of vertebral height to PKP for the treatment of Kümmell's disease. PKP has a significant advantage over PVP in term of the fewer cement leakages.

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“…However, a previous study hypothesized that the osteolysis rate among patients with Kümmell’s disease is greater than the rate of bone callus formation. Following PVP or PKP, accelerated osteolysis occurs and may displace the bone cement (21). Two case reports have focused on bone cement displacement following PVP (22) or PKP (23) alone for Kümmell’s disease without neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell’s disease with neurological deficits

Zhang

Gao

Zheng

et al. 2012

Experimental and Therapeutic Medicine

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The aim of this study was to investigate the treatment of Kümmell’s disease with neurological deficits and to determine whether intravertebral clefts are a pathognomonic sign of Kümmell’s disease. A total of 17 patients who had initially been diagnosed with Kümmell’s disease were admitted, one patient was excluded from this study. Posterior decompression and vertebroplasty for the affected vertebrae were conducted. Pedicle screw fixation and posterolateral bone grafts were performed one level above and one level below the affected vertebrae. Vertebral tissue was extracted for histopathological examination. The mean time of follow-up was 22 months (range, 18 to 42 months). The anterior and middle vertebral heights were measured on standing lateral radiographs prior to surgery, one day postoperatively and at final follow-up. The Cobb angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. The VAS, anterior and middle vertebral heights and the Cobb angle were improved significantly one day postoperatively and at the final follow-up compared with the preoperative examinations (P<0.05). No significant differences were observed between the one-day postoperative results and those at final follow-up (P>0.05). The neurological function of all patients was improved by at least one Frankel grade. All patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. One patient (not included in this study) showed an intravertebral cleft, but the pathology report indicated a non-Hodgkin’s lymphoma. The intravertebral cleft sign is not pathognomonic of Kümmell’s disease. Posterior decompression with short-segment fixation and fusion combined with vertebroplasty is an effective treatment for Kümmell’s disease with neurological deficits.

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Expert’s comment concerning Grand Rounds case entitled “Kümmell’s disease: delayed post-traumatic osteonecrosis of the vertebral body” (by R. Ma, R. Chow, F. H. Shen)

Cited by 25 publications

References 7 publications

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell’s disease

Posterior decompression and short segmental pedicle screw fixation combined with vertebroplasty for Kümmell’s disease with neurological deficits

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