Skip to main content

Advertisement

SpringerLink
Log in

Revisiting Kümmell’s disease: MRI findings beyond the intraosseous cavity for improved diagnosis

  • Spinal Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

The diagnostic tool for Kümmell’s disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD.

Methods

A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15 years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student’s t-test and area under the curve (AUC) analyses.

Results

KD was diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD (p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64 days in the KD group and 14 days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001).

Conclusions

Prevertebral soft-tissue changes and intraosseous cavity are associated with KD. Combined findings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

All data and materials support their published claims and comply with field standards.

Code availability

No specific software or code applicable.

Abbreviations

ON:

Osteonecrosis

KD:

Kümmell’s disease

IVC:

Intravertebral cleft

IOC:

Intraosseous cavities

PreSC:

Prevertebral soft-tissue changes

PoF:

Posterior wall fracture

PLCT:

Posterior ligamentous complex tear

PLC:

Posterior ligamentous complex

T1WI:

T1-weighted image

T2WI:

T2-weighted image

NPV:

Negative predictive value

PPV:

Positive predictive value

PACS:

Picture archiving and communication systems

EMR:

Electronic medical records

ESR:

Electronic erythrocyte sedimentation rate

CRP:

c-Reactive protein

WBC:

White blood cell count

References

  1. Kümmell H (1895) Die rarefizierende ostitis der wirbelkörper. Deutsche Med 21(1):180–181

    Article  Google Scholar 

  2. Kim YC, Kim YH, Ha KY (2014) Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J 14(4):659–666

    Article  Google Scholar 

  3. Lim J, Choi SW, Youm JY, Kwon HJ, Kim SH, Koh HS (2018) Posttraumatic delayed vertebral collapse : Kummell’s disease. J Korean Neurosurg Soc 61(1):1–9

    Article  Google Scholar 

  4. Kim HS, Heo DH (2016) Percutaneous pedicle screw fixation with polymethylmethacrylate augmentation for the treatment of thoracolumbar intravertebral pseudoarthrosis associated with Kummell’s osteonecrosis. Biomed Res Int 2016:3878063

    PubMed  PubMed Central  Google Scholar 

  5. Matzaroglou C, Georgiou CS, Panagopoulos A, Assimakopoulos K, Wilke HJ, Habermann B, Panos G, Kafchitsas K (2014) Kummell’s disease: clarifying the mechanisms and patients’ inclusion criteria. Open Orthop J 8:288–297

    Article  Google Scholar 

  6. Maldague BE, Noel HM, Malghem JJ (1978) The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology 129(1):23–29

    Article  CAS  Google Scholar 

  7. Kim DY, Lee SH, Jang JS, Chung SK, Lee HY (2004) Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg 100(1 Suppl Spine):24–31

    PubMed  Google Scholar 

  8. Libicher M, Appelt A, Berger I, Baier M, Meeder PJ, Grafe I, Dafonseca K, Noldge G, Kasperk C (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17(9):2248–2252

    Article  Google Scholar 

  9. Mirovsky Y, Anekstein Y, Shalmon E, Peer A (2005) Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol 26(7):1634–1640

    PubMed  PubMed Central  Google Scholar 

  10. Theodorou DJ (2001) The intravertebral vacuum cleft sign. Radiology 221(3):787–788

    Article  CAS  Google Scholar 

  11. Young WF, Brown D, Kendler A, Clements D (2002) Delayed post-traumatic osteonecrosis of a vertebral body (Kummell’s disease). Acta Orthop Belg 68(1):13–19

    CAS  PubMed  Google Scholar 

  12. Hwang Y, Kim YJ (2018) Retrograde cerebral venous air embolism on susceptibility-weighted imaging. Can J Neurol Sci 45(4):464–465

    Article  Google Scholar 

  13. Ahn SE, Ryu KN, Park JS, Jin W, Park SY, Kim SB (2016) Early bone marrow edema pattern of the osteoporotic vertebral compression fracture: can be predictor of vertebral deformity types and prognosis? J Korean Neurosurg Soc 59(2):137–142

    Article  CAS  Google Scholar 

  14. Ha KY, Kim YH (2013) Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporos Int 24(4):1207–1213

    Article  CAS  Google Scholar 

  15. Yu CW, Hsu CY, Shih TT, Chen BB, Fu CJ (2007) Vertebral osteonecrosis: MR imaging findings and related changes on adjacent levels. AJNR Am J Neuroradiol 28(1):42–47

    PubMed  PubMed Central  Google Scholar 

  16. Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T (2005) Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18(4):376–381

    Article  Google Scholar 

  17. Ioannidis JPA (2018) The Proposal to Lower P Value Thresholds to 005. JAMA 319(14):1429–1430

    Article  Google Scholar 

  18. Baur A, Stabler A, Arbogast S, Duerr HR, Bartl R, Reiser M (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225(3):730–735

    Article  Google Scholar 

  19. Dupuy DE, Palmer WE, Rosenthal DI (1996) Vertebral fluid collection associated with vertebral collapse. AJR Am J Roentgenol 167(6):1535–1538

    Article  CAS  Google Scholar 

  20. Formica M, Basso M, Cavagnaro L, Formica C, Zanirato A, Felli L (2016) Kummell disease: illustrative case for definition criteria. Spine J 16(10):e707–e708

    Article  Google Scholar 

  21. Ma R, Chow R, Shen FH (2010) Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body. Eur Spine J 19(7):1065–1070

    Article  Google Scholar 

  22. Kim H, Jun S, Park SK, Kim GT, Park SH (2016) Intravertebral vacuum cleft sign: a cause of vertebral cold defect on bone scan. Skeletal Radiol 45(5):707–712

    Article  Google Scholar 

  23. Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME (2007) Part II: spinal-cord neoplasms–primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 8(2):137–147

    Article  Google Scholar 

  24. Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS (2009) MR imaging assessment of the spine: infection or an imitation? Radiographics 29(2):599–612

    Article  CAS  Google Scholar 

  25. Voormolen MH, van Rooij WJ, van der Graaf Y, Lohle PN, Lampmann LE, Juttmann JR, Sluzewski M (2006) Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome. AJNR Am J Neuroradiol 27(5):983–988

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea

    Sung Hyun Yu & Yu Mi Jeong

  2. Department of Radiology, College of Medicine, The Catholic University of Korea Eunpyeong St. Mary’s Hospital, Tongil-ro, Eunpyeong-gu, Seoul, 1021, Korea

    Sheen-Woo Lee

Authors
  1. Sung Hyun Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Mi Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheen-Woo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study. Conceptualization: Sheen-Woo Lee; methodology, Sheen-Woo Lee; formal analysis and investigation: Sung Hyun Yu, Sheen Woo Lee, and Yu Mi Jung; writing — initial draft of the manuscript: Sung Hyun Yu; review and editing: Sheen-Woo Lee, Yu Mi Jung; ethics committee approval: Sung Hyun Yu, Yu Mi Jung; two first authors contributed in similar degree in this study. Supervision: Sheen Woo Lee. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sheen-Woo Lee.

Ethics declarations

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes, and was approved by the Institutional Review Board (approval no: GCIRB2021-223). The waiver of informed consent was granted from the institutional IRB.

Consent to participate

This research study was conducted from data obtained for clinical purposes, and informed consent was waived.

Consent for publication

This retrospective research study was conducted from data obtained for clinical purposes, and informed consent was waived.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Sung Hyun Yu is first author, and Yu Mi Jung is co-first author.

Highlights

• Concurrent MRI finding of intraosseous cavity, the prevertebral soft tissue change can help diagnose Kümmell’s disease (KD).

• Combining intraosseous cavity, an important finding in KD, with prevertebral findings, may facilitate earlier diagnosis.

• KD has no significant association with posterior wall fracture or PLC injury.

Supplementary Information

Below is the link to the electronic supplementary material.

234_2022_2976_MOESM1_ESM.jpg

Supplementary file1 (JPG 206 KB) Supplementary figure. A PreSC thickness was measured on the solid soft-tissue lesion on sagittal T1-weighted images (arrow) outside the boundary of dark cortical bone outline, effacing the prevertebral fat tissue around the anterior longitudinal ligament and segmental vessel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, S.H., Jeong, Y.M. & Lee, SW. Revisiting Kümmell’s disease: MRI findings beyond the intraosseous cavity for improved diagnosis. Neuroradiology 64, 1681–1688 (2022). https://doi.org/10.1007/s00234-022-02976-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-022-02976-z

Keywords

Search

Navigation