Kümmell’s Disease: Clarifying the Mechanisms and Patients’ Inclusion Criteria
Charalampos Matzaroglou 1, Christos S Georgiou 1, Andreas Panagopoulos*, 1, Kostantinos Assimakopoulos 2, Hans J Wilke 3, Bjoern Habermann 4, George Panos 5, Konstantinos Kafchitsas 5
Identifiers and Pagination:Year: 2014
First Page: 288
Last Page: 297
Publisher ID: TOORTHJ-8-288
Article History:Received Date: 10/1/2014
Revision Received Date: 31/7/2014
Acceptance Date: 11/8/2014
Electronic publication date: 15 /9/2014
Collection year: 2014
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.