Pathogenesis of the intravertebral vacuum of Kümmell's disease

Abstract

In this review, we explored the progress of the pathogenesis of Kümmell's disease intravertebral vacuum. Using different expressions of the same disease including ‘Kümmell's disease’, ‘avascular necrosis after vertebral compression fracture (VCF)’, ‘post-traumatic vertebral osteonecrosis’, ‘vertebral pseudarthrosis’, ‘intravertebral vacuum (cleft or gas)’, ‘delayed vertebral collapse’, ‘VCF nonunion’, and by conducting a search of the PubMed database, we analyzed the results to examine the pathogenesis of the intravertebral vacuum of Kümmell's disease after referring to pertinent literature on intravertebral vacuum of ischemic necrosis after VCF, and exploring the progress of pathogenesis of this disease. A number of discrepancies were identified within the pathogenesis of the intravertebral vacuum after VCF. There were statements such as avascular necrosis of the vertebral body, bone biomechanics, gas forming and other types of claims, all of which obtained clinical and biomechanical supporting evidence. Collectively, most of the researchers believe that Kümmell vertebral fracture syndrome was the comprehensive effect of multiple factors including osteoporosis, avascular necrosis of the vertebral body, and biomechanical changes following fracture. However, there are a number of discrepancies to be resolved and future studies are therefore needed.

Effect of teriparatide (rh-PTH 1–34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study

“…Vertebral non-union typically has been reported to occur mainly in the thoracolumbar zone [9, 13]. This phenomenon occurs due to the high stresses in this region generated by the transition from the rigid thoracic spine to the flexible lumbar spine along with the anterior element force transmission from the kyphotic thoracic spine to the relatively neutral thoracolumbar junction.…”

“…These factors might be considered related to the vulnerability of the small blood-supplying arteries in the vertebral bodies. Interruption of the blood supply and insufficient bone marrow neovascularization are the likely causes of avascular necrosis of the vertebral body, which may result in vertebral non-union [10, 13, 29]. Once vertebral necrosis occurs, union is difficult to achieve in the presence of a vertebral cleft.…”

“…In particular, balloon kyphoplasty (BKP) may correct vertebral body height and local kyphotic deformity [11]. However, the differences in pain control between patients who received non-surgical care and kyphoplasty treatment were diminished at 12 months because the non-surgical group improved over time, probably as a result of fracture healing [12, 13]. Differences in the eventual outcome of patients with OVCF depend greatly on the union status.…”

The clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction in the treatment of Kümmell’s disease

“…The most literatures reported that Kümmell's disease is associated with ischemic osteonecrosis and pseudoarthrosis formation [1,9,10]. There are obvious fissures and cavities in Kümmell's disease [11].…”

Failed Percutaneous Vertebroplasty Due to Insufficient Correction of Intravertebral Instability in Kummell's Disease: A Case Report

“…Kummell's disease has a broad spectrum of clinical manifestations; therefore, multiple synonymous terms have been used to describe this pathology: post‐traumatic vertebral osteonecrosis or avascular necrosis, vertebral pseudarthrosis, intravertebral vacuum cleft or gas, delayed vertebral collapse, and vertebral compression fracture nonunion . Vertebral compression fractures are not only painful, but can also cause intravertebral instability . Particularly in Kummell's disease, intravertebral instability from nonunion of the vertebral fracture can cause persistent severe pain and dysfunction…”