Abstract：
:The German doctor Hermann Kümmell described Kümmell's disease as the clinical scenario in which patients suffer a trivial spinal trauma, but develop a symptomatic, progressive, angular kyphosis after a symptom-free period of months to years. Since an intravertebral vacuum phenomenon, which is considered indicative of ischemic osteonecrosis, is often seen in the radiographs of patients with Kümmell's disease, most authors regard ischemic necrosis of the vertebral body as the primary pathogenesis of Kümmell's disease. However, we argue that Kümmell's disease is not commonly associated with typical avascular osteonecrosis of the femoral head and the intravertebral vacuum phenomenon is also present in other diseases. We postulated that even if ischemia plays a role in the pathogenesis of Kümmell's disease, it would not be the proximal cause of Kümmell's disease. In this article, we review the role of fluid shear stress in bone remolding and propose a microcosmic hypothesis in which microcracks lead to decreased fluid shear stress, which acts as the primary cause of Kümmell's disease. This was supported by conclusions drawn from a literature review: (1) fluid shear stress plays a crucial role in bone remodeling, and the osteocyte network is the main sensor of this mechanical stimulus; (2) decreased fluid shear stress will cause disequilibration of bone homeostasis, increasing bone resorption and reducing bone formation; and (3) the fluid flow of lacunar-canalicular porosity (PLC) and fluid shear stress near the microcracks decreases.
journal_name
Med Hypothesesjournal_title
Medical hypothesesauthors
Li H,Liang CZ,Shen CC,Chen QXdoi
10.1016/j.mehy.2011.08.005subject
Has Abstractpub_date
2011-11-01 00:00:00pages
897-9issue
5eissn
0306-9877issn
1532-2777pii
S0306-9877(11)00397-5journal_volume
77pub_type
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