KUMMEL DISEASE

From Big Medical Encyclopedia

KUMMEL DISEASE ( H. Kummell , it is mute. surgeon, 1852 — 1937; synonym: traumatic spondylitis, Kyummell's disease — Verneuil) — the disease of a backbone which is shown wedge-shaped deformation of one of vertebrae and local pains.

It is for the first time described by A. A. S. Verneuil, however the most detailed description under the name «traumatic spondylitis» is submitted by G. Kyummell in 1895.

About frequency To. among other diseases of a backbone of data in literature is not present. To. occurs at men of young and middle age, and one of chest vertebrae is surprised more often though also damage of lumbar vertebras is possible. Essence To. it is not clear, however all authors connect its emergence with an injury. The main manifestation To. the wedge-shaped deformation of a body of a vertebra similar to that is, edges it is observed at a compression fracture of a vertebra. Therefore many authors in general call into question existence To. as independent disease, considering that To. — it is out of time diagnosed compression fracture of a vertebra. At the same time there is also other opinion: assume that in a basis

To. the partial aseptic necrosis of a spongy bone of a body of a vertebra as a result of damage at an injury of intraspinal vessels lies. However the evidence of this hypothesis is not produced. In any case the term «traumatic spondylitis» is wrong since this disease of noninflammatory character.

A clinical picture

the Current To. it consists of three stages. As a result of a spine injury there is local pain in its chest department of this or that degree of intensity lasting for several days (the first stage). Unlike a compression fracture of a vertebra, this pain does not cause a feeling «intercepted breath» that is characteristic of a compression change.

In 1 — 2 week pain disappears and the disease passes into the second, latent, a stage when no pains and other unpleasant feelings from a backbone are noted. This stage can last several months, is more rare than years then there comes the third stage. For no reason at all or after a repeated injury there are again pains similar to that which were observed in the first stage. These pains sometimes irradiate on intercostal nerves. Mobility of chest department of a backbone is limited. The insignificant arc-shaped forms kyphosis (see), sometimes a kyphoscoliosis (see. Scoliosis ).

Diagnosis

Fig. 1. the roentgenogram of lumbar department of a backbone at Kyummell's disease (a direct back projection): wedge-shaped deformation of the III lumbar vertebra owing to moderate flattening of the right upper edge of his body is visible (it is specified by an arrow).
Fig. 2. The roentgenogram of chest department of a backbone at Kyummell's disease (a side projection): the compression of a vertebra (is specified by an arrow) which developed in 10 months after an injury.

For diagnosis To. apply a X-ray analysis of a backbone in two standard projections — a straight line back and side. However as patol, changes of the affected vertebra in initial stages To. are not so considerable, and imposing of shadows of adjacent anatomic educations on the wounded vertebra interferes them with identification, the usual X-ray analysis often does not give the sufficient grounds for sure recognition To. In these cases it is quite often shown tomography (see), thanking a cut in the first stage the crack of a vertebra, traumatic cartilaginous hernia can be revealed, and in the second — depression of spongy structure of a vertebra — osteoporosis is observed. In the third stage the wedge-shaped compression of the affected vertebra (fig. 1 and 2) is defined patol.

Differential diagnosis carry out with a compression change (see. Backbone ), tubercular spondylitis (see), Sheyermann's diseases — May (see. Sheyermanna — Mau a disease ), Kalva (see. to Kalva disease ), metastasises of tumors in a body of a vertebra. Differential diagnosis with a compression change is very difficult. In advantage To. tells lack of deformation of a body of a vertebra in the first stage. However during this period patients seldom see a doctor and the X-ray analysis of a backbone is even less often made.

Unlike a tubercular spondylitis, at To. there are no abscesses, the kyphosis has the characteristic form. Tubercular damages of one vertebra in clinic practically do not meet. Sheyermann's diseases — May, Kalva are observed at youthful age and have characteristic rentgenol, a picture.

At metastasises of malignant tumors in a body of a vertebra of pain gradually accrue, have the exhausting character, nevrol, complications rather quickly develop. At diagnostic doubts it is necessary to make rentgenol, inspection of other departments of a skeleton, in particular skulls, a basin, edges, long tubular bones, and to make the diagnosis on the basis of comparison of all available rentgenol, symptoms about a wedge, yielded and results a lab. and biochemical, researches.

Treatment

Treatment comes down to unloading of a backbone. At pains appoint a bed rest on a flat bed with the small roller under area of a kyphosis, after reduction of pains — a removable corset, the backboard. Are shown to lay down. gymnastics, massage. A main objective of these procedures — strengthening of muscles of a back, but not increase in amplitude of movements of a backbone. Also physiotherapeutic procedures are shown.

The forecast

the Forecast is defined by expressiveness of effects and timeliness of treatment. An effect To. usually insignificant deformation of a backbone as a kyphosis or a kyphoscoliosis and osteochondrosis of a backbone is.


Bibliography: The multivolume guide to traumatology and orthopedics, under the editorship of N. P. Novachenko, t. 3, page 271, M., 1968; P e y N - e r S. A. Radiodiagnosis of bones and joints, t. 1, page 97, M., 1964; T and of e r I. L. and D I am the p e of N to about V. A. Radiodiagnosis of diseases of a backbone, page 97, M., 1971; Kiimmell H. Die posttraumatische Wirbelerkrankung (Kum-mellsche Krankheit), Langenbecks Arch, klin. Chir., Bd 118, S. 876, 1921; about N of e, Der heutige Standpunkt der posttraumati-schen Wirbelerkrankungen (Kiimmellsche Krankheit), Arch, orthop. Unfall-Chir., Bd 26, S. 471, 1928; Lehrbuch der Orthopa-die, hrsg. v. P. F. Matzen, Bd 2, S. 170, B., 1967.


I. A. Movshovich; L. M. Freydin (rents.).

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