Kümmell's disease in benign vertebral compression fractures: Incidence, risk factors, and outcomes following percutaneous vertebroplasty.

BACKGROUND

Kümmell's disease (KD) is a delayed consequence of vertebral compression fracture (VCF), usually after minor trauma. Its incidence and prognosis remain uncertain.

OBJECTIVE

To determine the incidence and predictors of KD in patients with benign vertebral VCF and to assess outcomes of percutaneous vertebroplasty (VP).

METHODS

A retrospective cohort of 656 patients with insufficiency-type VCFs aged > 20 years was analyzed in Shiraz (2004-2024). Logistic regression identified factors associated with KD. VP outcomes were evaluated using pre- and post-treatment Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Statistical significance was set at p < 0.05.

RESULTS

Among 656 VCF patients (435 F, 221 M), 77 (11.7 %) had KD. KD patients were older (79.2 vs. 72.4), more often male (37.7 % vs. 24.9 %), and had lower BMI (22.3 vs. 23.1). KD was linked to prior CVA (45.5 % vs. 15.9 %), mild CRP elevation (23.1 vs. 22.3), and lower spine BMD (T-score -3.0 vs. -2.1). CVA history, elevated CRP, and osteoporosis were independent KD risk factors; higher BMI was protective. VP led to significant improvements in VAS, ODI, and kyphotic angle (all p < 0.001); The operative outcomes and complication rates did not differ significantly between KD and non-KD patients.

CONCLUSION

We identified key clinical characteristics associated with KD, including osteoporosis, prior CVA, mild elevations in CRP levels, and advanced age. The increasing prevalence of KD, driven by an aging population and improved diagnostic modalities, suggests that it should no longer be viewed as a rare entity.