Avascular Necrosis: Risk Factors, Diagnosis and Treatment

Kummel disease is a rare type of AVN affecting the spine.

Avascular necrosis (also known as AVN, osteonecrosis, aseptic necrosis, and ischemic bone necrosis) refers to a loss of blood supply to your bones. When your bones lack proper nourishment from blood, they can die and collapse. While AVN can affect any bone, it rarely occurs in your spinal bones (thoracic vertebrae). AVN of the spine is also known as vertebral osteonecrosis or Kummel disease.
Magnetic resonance imaging series of the thoracic and lumbar spineMagnetic resonance imaging series of the thoracic and lumbar spine demonstrates a thoracic vertebral spinal fracture with spinal cord compression (myelopathy).

Kummel Disease and Vertebral Fracture

Kummel disease is AVN that occurs after a vertebral compression fracture (VCF) fails to heal properly. You may suffer a minor fall or injury that leads to a VCF—this is particularly common for elderly adults and people with osteoporosis.

VCFs are common in people with osteoporosis because that condition weakens your bones—they can become so weak, in fact, that even a sudden cough can damage vertebral body.

Several treatments can help your spinal fractures heal, but they sometimes do not heal properly. After a spinal fracture, the blood vessels may be damaged. This can interfere with the blood circulation to the bone and lead to Kummel disease weeks or months after the initial injury.

If Kummel disease progresses, you may develop a spinal deformity known as kyphosis. Fractured spinal vertebrae that don’t properly heal change into a wedge-like shape, causing the vertebrae to fall onto one other and develop an abnormal spinal curve.

Who Is Likely to Develop Avascular Necrosis or Kummel Disease?

As many as 20,000 people learn they have AVN each year, so it’s a rare disorder. The Kummel disease form of AVN is even rarer. However, medical researchers believe the prevalence of the condition will increase as the general population ages and becomes more susceptible to osteoporosis.

About 54 million Americans have or are at risk for developing osteoporosis. Approximately 50% of women and 25% of men age 50 and over will experience an osteoporosis-related fracture, research shows.

Though osteoporosis is a common cause of bone mass loss, it’s not the only one. People who are nutritionally deficient, which is a struggle for some elderly people, are also at risk for spinal fracture and, thus, Kummel disease (vertebral osteonecrosis).

Risk Factors

While osteoporosis and aging are common risk factors for Kummel disease, other cases of AVN may be caused by different non-traumatic factors. Risk factors associated with non-traumatic AVN include alcoholism, Gaucher disease (occurs when high amounts of fatty substances collect in the organs), pancreatitis, radiation treatments and chemotherapy, chronic use of corticosteroids (eg, prednisone), and blood disorders such as Sickle cell disease.

What Are the Symptoms?

In the early stages of AVN and Kummel disease, you may not have any symptoms. But as the disease progresses, most people with Kummel disease experience back pain. Pain usually develops gradually and may be mild or severe. If the bone and surrounding joint surface collapses, pain may develop or increase dramatically.

Pain may be severe enough to limit your range of motion in your spine, and some people with Kummel disease have neurological symptoms like numbness and tingling. The time between the first symptoms of Kummel disease and loss of function is different for each person, ranging from several months to more than a year.

Diagnostic Imaging Tests

An x-ray is a common first-line diagnostic tool that your doctor may use to help diagnose AVN and Kummel disease. It is a simple way to produce pictures of bones, but it has limitations. For instance, an x-ray of a person with early AVN is likely to be normal because x-rays are not sensitive enough to detect the bone changes in the early stages of the disease. X-rays can show bone damage in the later stages, they are often used to monitor the course of the condition after a diagnosis is confirmed.

Magnetic resonance imaging (MRI is quickly becoming a common method for diagnosing avascular necrosis and Kummel disease. Unlike x-rays, bone scans, and computed/computerized tomography (CT) scans, MRI detects chemical changes in the bone marrow and can show the disorder in its earliest stages. MRI provides your doctor with a picture of the affected vertebrae and the bone-rebuilding process. In addition, MRI may show diseased areas that are not yet causing any symptoms.

What Treatments Are Available?

Several treatments are available that can help prevent further bone and joint damage and reduce pain. To determine the most appropriate treatment, your doctor will consider:

  • Your age
  • The stage of your disease (early or late)
  • The location (eg, thoracic spine) and amount of bone affected

If your Kummel disease is diagnosed early, your doctor may use a conservative treatment approach first. Pain medications and physical therapy may be among the ways your doctor recommends managing pain and improving spine strength and flexibility.

Reduced Weight Bearing
If AVN is diagnosed early, your doctor may start you on a conservative treatment plan by having you limit the amount of weight you place on your spine. In some cases, reduced weight bearing can slow the damage caused by avascular necrosis and permit natural healing. When combined with medication to reduce pain, reduced weight bearing can be an effective way to avoid or delay surgery for some people. However, most people eventually will need surgery to permanently treat the disorder.

Spine Surgery
But for many people, spine surgery is necessary to provide long-term pain symptom progression. Depending on how the disorder has affected you, your surgeon may use one or a combination of surgical approaches to address the full scope of your symptoms. Below are some procedures your doctor may recommend:

  • Vertebroplasty or kyphoplasty: These minimally invasive procedures use bone cement to treat spinal fractures.
  • Osteotomy, spinal instrumentation and fusion: These procedures may be used if you have developed kyphosis. Together, they may prevent the abnormal curve from getting worse.
  • Spinal decompression surgery (such as a foraminotomy): Decompression procedures create space around cramped “compressed” spinal nerves. If nerve-related pain is associated with your Kummel’s disease, your doctor may recommend a surgical decompression procedure.

Where Can I Find More Information About Kummell Disease and Avascular Necrosis?

If you had a spinal injury resulting in a vertebral compression fracture within the past year and suspect it hasn’t properly healed, talk to your doctor or spine specialist. He or she can help get to the bottom of your pain and help ease your concerns. If you have Kummel disease, or trauma-related avascular necrosis in your spine, your doctor can craft a customized treatment plan to addresses the full range of your symptoms.

Updated on: 09/05/18
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Avascular Necrosis: What is it?
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Avascular Necrosis: What is it?

Kummel disease is a rarely occurring variation of avascular necrosis that can affect the spine’s vertebrae, usually the thoracic spine (mid back) region.
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