The Intravertebral Vacuum Phenomenon ("Vertebral Osteonecrosis")

Lafforgue, P.; Chagnaud, Christophe; Daumen-Legre, V.; Daver, L.; Kasbarian, M; Acquaviva, P

doi:10.1097/00007632-199708150-00015

Cited by 70 publications

(24 citation statements)

References 21 publications

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“…The hypothesis of an ischemic necrosis is generally advanced to explain the time lag between the traumatic event and the eventual VBC. This hypothesis was supported by the following arguments: i) findings of bone necrosis was found in the cases sampled for biopsy [2, 3, 13, 14, 17] ii) a history of steroid treatment or alcohol abuse, which are well known risk factors of avascular necrosis of the femoral head, was found in some patients with KD [9-12] iii) coexistence of avascular necrosis of the femoral head and vertebral osteonecrosis was, also, found in some patients [31, 32] and iv) some radiographic analogies between the crescent sign of avascular necrosis of the femoral head and the IVC has been pointed out [33]. Injury seems to trigger vascular supply disruption [5].…”

Section: Histopathology and Pathophysiologymentioning

confidence: 99%

“…However, all these arguments are a subject for discussion. The association of avascular necrosis of the femoral head and ischemic vertebral collapse is not strongly enough supported, as only three cases have been reported in the literature [31-33]. Furthermore, contrary to vertebral osteonecrosis, spontaneous intraosseous gas formation is not observed in cases of avascular necrosis of the femoral head [33].…”

Section: Histopathology and Pathophysiologymentioning

confidence: 99%

“…A third theory, which, however, had limited acceptance, suggested that intravertebral gas could be of intradiskal origin, since a high coincidence (83%) of intervertebral disc vacuum was noted in cases of IVC (Fig. 2B ) [31]. Spinal infection, on the other hand, may rarely be accompanied by intradiscal or intraosseous gas so that the latter finding does not entirely exclude the possibility of infection [64].…”

Section: Kümmell’s Disease and Intravertebral Vacuum Cleftmentioning

confidence: 99%

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Kümmell’s Disease: Clarifying the Mechanisms and Patients’ Inclusion Criteria

Matzaroglou

Georgiou

Panagopoulos

et al. 2014

TOORTHJ

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The three major causes of vertebral body collapse include infection, malignant neoplasia, and trauma and it may be difficult to distinguish between them, particularly in the presence of severe osteoporosis. In 1891, however, Dr Hermann Kümmell, further added another possibility of vertebral body crush; the delayed posttraumatic collapse. As originally described, this rare clinical entity includes patients, who after a trivial trauma and an asymptomatic clinical course they develop a progressive vertebral body collapse and a painful kyphosis. Although more than a century has passed from its initial description, only few cases have been reported in the literature, whereas the main pathologic eliciting event is still under investigation. As a consequence, great controversy exists regarding the discrete features of the clinical course, its radiographic appearance and the histopathological findings. To explain the time lag between the initial trauma and the occurrence of the vertebral collapse, the hypothesis of ischemic necrosis was advanced. Equation of Kümmell’s disease with vertebral osteonecrosis, however, has wrongly led many authors to report cases of Kümmell’s disease, even in the absence of history of spinal trauma. On the other hand, high coincidence of vertebral osteonecrosis and the pathognomonic radiographic finding of intravertebral vacuum cleft, has further added to the confusion. In this review we present an overview of the literature on Kümmell’s disease, focusing on the different proposed eliciting mechanisms. We also highlight controversial subjects on clinical course, diagnosis and treatment of this entity, in an attempt to further clarify patients’ inclusion criteria.

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Section: Histopathology and Pathophysiologymentioning

confidence: 99%

Section: Histopathology and Pathophysiologymentioning

confidence: 99%

Section: Kümmell’s Disease and Intravertebral Vacuum Cleftmentioning

confidence: 99%

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Kümmell’s Disease: Clarifying the Mechanisms and Patients’ Inclusion Criteria

Matzaroglou

Georgiou

Panagopoulos

et al. 2014

TOORTHJ

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“…The main hypothesis is the ischemic theory8. Maldague et al3, since their original description, have stated that the presence of gas in the vertebral bodies implies the absence of fluid or blood at the fracture site, i.e., ischemia.…”

Section: Introductionmentioning

confidence: 99%

“…Maldague et al3, since their original description, have stated that the presence of gas in the vertebral bodies implies the absence of fluid or blood at the fracture site, i.e., ischemia. However, there is currently no proof that ischemia or osteonecrosis serves as the major pathologic mechanisms of the intra-vertebral vacuum phenomenon8. The proposed absence of fluid in the vertebral cleft is contradicted by MR imaging, which clearly demonstrates the presence of a fluid-like collection associated with gas in the vertebral body4,8-10.…”

Section: Introductionmentioning

confidence: 99%

Delayed Post-traumatic Vertebral Collapse: MR Categorization and MR-Pathology Correlation

Lee

Chung

et al. 2007

Asian Spine J

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Study DesignA retrospective study.PurposeTo categorize the MR appearance of ischemic vertebral collapse and to correlate surgical and histologic findings.Overview of LiteratureX-ray and MRI findings of delayed posttraumatic vertebral collapse shows several patterns. Histopathologic signs of osteonecrosis were present only in minor portion of cases sampled for biopsy of delayed post-traumatic vertebral collapse in the literature.MethodsTwenty-one patients (22 vertebral bodies), with surgically and histopathologically proven ischemic vertebral collapse were included. The patients were examined with a 1.5 T MR imager. Spin echo T1- and T2-weighted images were obtained in axial and sagittal planes. Two experienced musculoskeletal radiologists, who reached consensus, evaluated the MR images. Then, MR-pathology correlations were made.ResultsFour different MR patterns were identified. Fluid patterns, were seen in 14% (3/22) of the affected vertebral bodies, and were characterized by hypo-intense signals on T1-weighted images, and hyper-intense signals, similar to water, on T2-weighted images. Extensive bone necrosis was predominant. Compression pattern, the most common pattern, found in 41% (9/22 vertebral bodies), was characterized by a marked decrease of anterior column height. Bone necrosis, granulation tissue, marrow fibrosis, and reactive new bone formation were found in relatively equal proportion. Granulation pattern, seen in 27% (6/22 vertebral bodies), was characterized by hypo-intense signals on T1-weighted images, and intermediate signals on T2-weighted images. Extensive granulation tissue was predominant. Mixed patterns were present in 18% (4/22), of the vertebral bodies.ConclusionsAwareness of histopathologic correlation of MR patterns in patients with delayed post-traumatic vertebral collapse may facilitate effective interpretation of clinical MR images of the spine.

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Intravertebral clefts in osteoporotic vertebral compression fractures

McKiernan

Faciszewski

2003

Arthritis & Rheumatism

130

118

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Objective. To describe the characteristics, radiographic appearance, and significance of intravertebral clefts in vertebral compression fractures (VCFs) of patients with osteoporosis presenting for vertebroplasty.Methods. This was a prospective radiographic study of 50 consecutive patients with 82 VCFs who underwent vertebroplasty at a tertiary referral center. Patients underwent imaging preoperatively with standing lateral and supine cross-table lateral radiographs and magnetic resonance imaging (MRI). Standing lateral radiographs were also obtained postoperatively. Clefts were defined at the time of vertebroplasty as confluent reservoirs for polymethylmethacrylate (PMMA). Postoperatively, all images were reexamined for the presence and characterization of intravertebral clefts.Results. Twenty-four of 50 patients (48%) had clefted VCFs, and 30 of 82 VCFs (37%) contained clefts. Clefted VCFs were severe, dynamically mobile, and occurred primarily in the thoracolumbar junction. Clefts were detectable by standing lateral radiography in 14%, by supine cross-table radiography in 64%, and by MRI in 96% of fractured vertebrae. Clefts occurred primarily in the anterosuperior portion of the vertebral body, and cleft margins appeared increasingly sclerotic in persistently mobile VCFs. PMMA fill patterns of clefted and unclefted VCFs were distinct.Conclusion. Intravertebral clefts occur frequently in osteoporotic VCFs of patients who present for vertebroplasty. The radiographic characteristics of clefts evolve over time and can be indistinguishable from Kümmell's disease in severe, persistently mobile, clefted osteoporotic VCFs.

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The Intravertebral Vacuum Phenomenon ("Vertebral Osteonecrosis")

Cited by 70 publications

References 21 publications

Kümmell’s Disease: Clarifying the Mechanisms and Patients’ Inclusion Criteria

Kümmell’s Disease: Clarifying the Mechanisms and Patients’ Inclusion Criteria

Delayed Post-traumatic Vertebral Collapse: MR Categorization and MR-Pathology Correlation

Intravertebral clefts in osteoporotic vertebral compression fractures

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