Kümmell disease is an eponymous name for osteonecrosis and collapse of a vertebral body.
Kümmell disease represents delayed (usually two weeks) vertebral body collapse due to ischaemia and non-union of anterior vertebral body wedge fractures after major trauma.
Risk factors include:
- corticosteroid use
- radiation therapy
Plain radiograph / CT
- shows collapse of affected vertebrae (typically lower thoracic and upper lumbar)
- an intravertebral vacuum cleft and fluid may be seen (accentuated on extension stress lateral views), although this is non-specific
- the intravertebral vacuum cleft is usually seen as low signal intensity with all sequences
- if intravertebral fluid is present it is low T1 signal and high T2 signal
The severity of the vertebral collapse has been found to be higher in those who have intravertebral gas compared to those who only have intravertebral fluid, signifying that the presence of intravertebral gas is possibly a more advanced stage of the disease 1.
History and etymology
This condition was first described by Hermann Kümmell (1852-1937), a German surgeon, in 1891 4,8.
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- 3. Freedman BA, Heller JG. Kummel disease: a not-so-rare complication of osteoporotic vertebral compression fractures. 22 (1): 75-8. doi:10.3122/jabfm.2009.01.080100 - Pubmed citation
- 4. Brower AC, Downey EF. Kümmell disease: report of a case with serial radiographs. Radiology. 1981;141 (2): 363-4. Radiology (citation) - Pubmed citation
- 5. Mirovsky Y, Anekstein Y, Shalmon E et-al. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol. 2005;26 (7): 1634-40. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 6. Theodorou DJ. The intravertebral vacuum cleft sign. Radiology. 2001;221 (3): 787-8. doi:10.1148/radiol.2213991129 - Pubmed citation
- 7. Donald L. Resnick, Mark J. Kransdorf. Bone and Joint Imaging E-Book. ISBN: 9781437720921
- 8. Klimpel V. [Our surgical heritage. Hermann Kümmell (1852-1937)]. Zentralblatt fur Chirurgie. 112 (9): 589-92. Pubmed