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The pathophysiology, clinical presentation, imaging and treatment options of this disease remain controversial. The most widely accepted hypothetical pathophysiology is avascular osteonecrosis. The intravertebral vacuum cleft phenomenon is considered a radiographic sign of avascular osteonecrosis of the vertebral body and is highly suggestive of K\u00fcmmell's disease. Treatment options include nonsurgical and surgical treatment, and percutaneous vertebral augmentation. The primary aims of surgical treatment of K\u00fcmmell's disease are neural decompression and stabilization of the spinal column. Surgery can involve an anterior, posterior, or combined anterior and posterior approach. Surgery and percutaneous vertebral augmentation provide significant symptomatic relief, functional improvement and deformity correction. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon.<\/jats:p>","DOI":"10.1177\/147323001204000202","type":"journal-article","created":{"date-parts":[[2013,2,27]],"date-time":"2013-02-27T14:22:55Z","timestamp":1361974975000},"page":"406-414","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":55,"title":["K\u00fcmmell's Disease, an Uncommon and Complicated Spinal Disorder: A Review"],"prefix":"10.1177","volume":"40","author":[{"given":"H","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C-Z","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Q-X","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,4,1]]},"reference":[{"key":"bibr1-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(51)90206-1"},{"key":"bibr2-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1016\/0049-0172(81)90004-4"},{"key":"bibr3-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-1205-4"},{"key":"bibr4-147323001204000202","first-page":"13","volume":"68","author":"Young WF","year":"2002","journal-title":"Acta Orthop Belg"},{"key":"bibr5-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000076824.61074.06"},{"key":"bibr6-147323001204000202","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3171\/jns.2004.100.1.0024","volume":"100","author":"Kim DY","year":"2004","journal-title":"J Neurosurg"},{"key":"bibr7-147323001204000202","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20080101-35"},{"key":"bibr8-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199307000-00019"},{"key":"bibr9-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-002-0418-5"},{"key":"bibr10-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181657f31"},{"key":"bibr11-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1067\/mmt.2002.123164"},{"key":"bibr12-147323001204000202","first-page":"52","volume":"13","author":"Matzaroglou C","year":"2010","journal-title":"Hell J Nucl Med"},{"key":"bibr13-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0094-z"},{"key":"bibr14-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1148\/129.1.23"},{"key":"bibr15-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199708150-00024"},{"key":"bibr16-147323001204000202","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2009.01.080100"},{"key":"bibr17-147323001204000202","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.141.2.7291557"},{"key":"bibr18-147323001204000202","unstructured":"Junghanns H, Schmorl G: The Human Spine in Health and Disease, 2nd edn (Besemann EF ed). 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