Double Vertebrae Kümmell Disease: Five Cases Report and Literature Review

Kümmell disease (KD) is a complication of osteoporotic vertebral compression fractures. There is a lot of literature on KD, but the reported cases are all single vertebrae. This study reports five double vertebrae KD cases (10 levels) and discusses the possible underlying mechanisms with a literature review. One hundred and thirty vertebrae KD were diagnosed from 2074 osteoporotic vertebral compression fractures patients treated in our hospital between 2015 and 2019. These vertebrae KD were divided into two groups, one-level vertebrae KD (n = 125) and double-level KD (n = 5). The diagnosis of KD is mainly based on the signs of intravertebral vacuum cleft on X-ray or CT scan. Double vertebrae KD cases were classified by using the KD staging system. The analysis was performed on KD to compare age, gender, femoral neck bone mineral density of femoral neck (BMD), vertebrae distribution, Cobb angle, and visual analog scale (VAS) between one-level KD and double-level by t-tests, Welch's t-test, or hypothesis testing. The mean age of the participants in the one-level KD group was 78.69 years, while the mean age in the double-level KD group was 82.4 years. The difference was statistically significant (t = 3.66, p = 0.0004). There were 89 females and 36 males in the one-level KD group, while the double-level KD group had five females and no males. The femoral neck BMD was significantly different between the two groups, with the one-level KD group having a mean BMD of -2.75 and the double-level KD group having a mean BMD of -4.2 (t = 2.99, p= 0.0061). The vertebrae distribution was different between the groups, with the one-level KD group having vertebrae from T7 to L4 and the double-level KD group having vertebrae from T11 to L1. The Cobb angle was also significantly different between the groups, with the one-level KD group having a mean angle of 20.58 and the double-level KD group having a mean angle of 31.54 (t = 6.22, p = 0.0001). Finally, the VAS scores were similar between the two groups, with the one-level KD group having a mean score of 8.63 and the double-level KD group having a mean score of 8.8 (t = 1.35, p = 0.1790). It is concluded that double vertebrae Kümmell disease has special clinical significance due to its potential to cause greater spinal instability and deformity, increased risk of neurological symptoms, more complex surgical management, and greater risk of complications.