STAGING OF KÜMMELL'S DISEASE

Abstract

Kümmell's disease is defined as delayed post-traumatic vertebral collapse, common in osteoporotic people with/without a trauma history. Its clinical course is progressive, and treatment modalities have to be tailored to the patient. In the literature, no staging system has been reported. Based on clinical symptomatology, radiographic and MRI imaging, a staging system for Kümmell's disease was developed. This study involved 129 Kümmell's disease patients with 348 compression fractures involving 136 vertebrae. The mean age was 72.5 ± 6.6 years, with a female to male ratio of 103 to 26. Osteoporosis is a common risk factor. Minor trauma can be traced in some of the patients. A three-stage system was proposed. Stage I: Intact or minor compression on plain X-ray films with signs of osteonecrosis on the MRI. Stage II: Body collapse with dynamic mobility, but with intact posterior body wall. Stage III: Collapse of posterior body wall with resultant cord compression. There were 19, 90 and 33 vertebrae respectively classified in Stages I, II and III. Kümmell's disease is most common threat to the thoracolumbar junction. Treatments based on clinical symptomatology and radiographic findings were well correlated with the staging system. The present staging system therefore seems appropriate to describe the natural course of Kümmell's disease and to guide management policy.