Definition, Diagnosis, Pathophysiology and Treatment of Kummell's Disease / 대한골다공증학회지

Over 100 years ago, Hermann Kummell described a clinical condition in which patients sustained a trivial trauma, had essentially asymptomatic period lasting weeks to months, then developed a painful, progressive angular kyphosis. Since then, many post-traumatic delayed kyphosis have been reported as a Kummell's disease. As a radiologic finding of intravertebral cleft sign was related to this delayed collapse, this abnormal gas or fluid signal in the involved vertebral body was considered as a pathognomic sign. However, recent evidences indicate this delayed progressive collapse and kyphosis of the spine is related to osteoporotic spine fracture in many reports. At this point, by defining and reviewing the definition and etiology of Kummell's disease, we have to look into whether Kummell's disease is a distinct or rare pathophysiologic entity or a complicated clinical result of osteoporotic spine fracture. In this review, author tried to clearly define the definition and diagnosis criteria to diagnose Kummell's disease as a complicated osteoporotic spine fracture and review treatment modalities for this complicated clinical condition.

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

STUDY DESIGN: A retrospective study. PURPOSE: To categorize the MR appearance of ischemic vertebral collapse and to correlate surgical and histologic findings. OVERVIEW OF LITERATURE: X-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. METHODS: Twenty-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. RESULTS: Four 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. CONCLUSIONS: Awareness 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.