Imaging Parameter Measurement And Clinical Significance Of Kümmell Disease

Objective: The incidence rates of intravertebral vacuum cleft(IVC)in various stages of Kümmell’s disease were measured and the imaging parameters of IVC in each stage of Kümmell’s disease were compared to explore the relationship between IVC and the severity of Kummell’s disease.The correlation between the course,lumbar bone density value,anterior compression of injured vertebrae,kiphotic Cobb Angle,and IVC imaging parameters of Kummell’s disease was determined.The possible mechanism of IVC was discussed by comparing the data of the group with and without IVC.Method: By inquiring the electronic medical record system,the vision picture archiving and communication system(VISIONPACS)clinical browsing system and the Hologic Discovery dual-energy X-ray bone densimeter operating system of the Second Affiliated Hospital of Inner Mongolia Medical University.All patients admitted to the Spinal Surgery Center of the Second Affiliated Hospital of Inner Mongolia Medical University from January 2019 to December 2022 were screened strictly according to the inclusion and exclusion criteria.A total of 89 patients diagnosed with Kümmell’s disease were included in the study.The patient’s gender,age,course of disease,diseased vertebra,lumbar vertebra bone density and other information were recorded.The height of the anterior edge of the injured vertebra,the height of the anterior edge of the adjacent vertebra above and below the injured vertebra,the Cobb Angle of the kiphosis and the imaging parameters of the IVC were measured,and the average of the height of the anterior edge of the injured vertebra and the height of the anterior edge of the adjacent vertebra above and below the injured vertebra was used to calculate the compression degree of the injured vertebra’s anterior edge.SPSS 25.0 statistical software was used to calculate the incidence of IVC in each stage of Kümmell’s disease.The correlation among lumbar bone density,disease course,kyphotic Cobb Angle,anterior margin compression and IVC imaging parameters was analyzed.By comparing the data of the group with IVC and the group without IVC,the possible factors affecting the occurrence of IVC were analyzed.The imaging parameters of different stages of IVC were compared to analyze the relationship between disease development and IVC.Results: In this study,the overall incidence of IVC in Kümmell’s patients was 37.1%.The incidence of IVC in stage Ⅰ patients was 15.4%.The incidence of IVC in stage II cases was25.7%.The incidence of IVC in stage III patients was 53.7%.The difference was statistically significant(P=0.009).There was a weak negative correlation between lumbar bone density and kyphotic Cobb Angle in Kümmell patients(r =-0.226,P=0.033).There was a weak negative correlation between lumbar bone density and anterior margin compression(r =-0.285,P =0.007).There was a high correlation between anterior margin compression and kyphotic Cobb Angle(r =0.646,P<0.001).There was no significant correlation between the course of disease and lumbar vertebra bone density,kyphotic Cobb Angle and vertebral anterior margin compression(P>0.05).There was a higher correlation between kyphotic Cobb Angle and vertebral anterior margin compression in the group with IVC(r =0.724,P<0.001).The maximum height of IVC was moderately negatively correlated with the compression degree of the anterior edge of the vertebral body(r =-0.414,P = 0.016).There was a high correlation between the maximum length and maximum width of IVC(r = 0.665,P<0.001).There was no significant correlation between the other data(P>0.05).There were significant differences between kyphotic Cobb angles in each stage(P<0.001).There was a significant difference in the compression degree of the anterior edge of the vertebrae in each stage(P<0.001).Lumbar vertebra bone density showed a decreasing trend in all periods,but the difference was not statistically significant(P>0.05).The course of disease in stage Ⅱ and stage Ⅲ was significantly longer than that in stage Ⅰ,but the difference was not statistically significant(P>0.05).There were no significant differences in age and sex(P>0.05).The kyphotic Cobb Angle was significantly higher in the group with IVC than in the group without IVC(P=0.001).The compression degree of anterior vertebral margin in the group with IVC was greater than that in the group without IVC(P =0.02).The lumbar vertebra bone density in the group with IVC was lower than that in the group without IVC,but the difference was not statistically significant(P>0.05).The proportion of women in the group with IVC was lower than that in the group without IVC,but the difference was not statistically significant(P>0.05).There were no significant differences in age and course of disease between the two groups(P>0.05).The incidence of IVC was weakly correlated with anterior margin compression(r =0.246,P=0.02)and moderately correlated with kyphotic Cobb Angle(r=0.344,P =0.001).The imaging parameters of IVC in each stage were compared,and the maximum width of IVC in each stage was different,there was a difference between stage Ⅰand stage Ⅲ(P<0.05),but there was no difference between stage Ⅰ and stage Ⅱ,stage Ⅱ and stage Ⅲ(P>0.05).The maximum length and height of stage Ⅱ and stage Ⅲ were significantly higher than those of stage Ⅰ,but there was no significant difference between the two stages(P>0.05).Conclusions: 1.The incidence of IVC was positively correlated with the compression degree of anterior vertebra and the Cobb Angle of kyphosis,and the incidence was positively correlated with the severity of Kümmell’s disease.2.The compression degree of the injured vertebral front and the Cobb Angle of the kyphotic spine in the presence of IVC group were significantly greater than those in the absence of IVC group,suggesting that the occurrence of IVC may be related to the increased local stress after the spinal biomechanical changes.3.The compression degree of the injured vertebral front,kyphotic Cobb Angle and lumbar vertebra bone density were negatively correlated,suggesting that the severity of Kümmell’s disease may be related to the degree of osteoporosis.4.The maximum height of IVC was negatively correlated with the compression degree of the injured vertebral front,while the maximum length of IVC was positively correlated with the maximum width of IVC,and the maximum width of IVC increased with the aggravation of Kümmell’s disease,suggesting that the height of IVC decreased with the collapse of the vertebral body,and the cross-sectional area might increase with the aggravation of the disease.