WITHDRAWN: Are intravertebral clefts Kümmell’s disease?

Abstract Purpose: Intravertebral clefts (IVC) used to be considered as the unique characteristic of Kümmell’s disease (KD). However, accumulating literatures and our clinical findings identified the presence of IVC in acute osteoporotic vertebral compression fractures (OVCF) as well. Since the exact time for incidence of OVCF is usually difficult to recall for old people, it leads to challenging to differentiate IVC from KD and acute OVCF and begs for further investigation. Moreover, the treatment scheme of the two is not exactly the same. In order to identify the differences between IVC of KD and OVCF, we performed this study of radiological features. Materials and Methods: Seventy-nine patients with IVC were included in our study, with 44 cases in the KD group and 35 cases in the acute OVCF group. Radiological images, including X-ray, CT, and MRI, were collected for each group. Results: Consistent with previous reports, IVC was present in both groups. Intriguingly, we found several unique features that were only present in the KD group, including sclerosis of the cleft margin (95.5%, 42/44), ossification of the fractured vertebrae (100%, 44/44), ossification of the pedicle (31.8%, 14/44), double-line sign (27.3%, 12/44), stress fracture of the spinous process (13.6%, 6/44) and even formation of paravertebral callus (18.2%, 8/44). Conclusion: IVC could present in patients with both KD and acute OVCF, which leads to the challenges in the differentiation of clinical diagnosis. Due to the differences in the treatment, it is essential for surgeons to identify the differences among radiological features between the two. We found that marginal cleft sclerosis, vertebral and pedicle ossification, double-line sign, spinous process fracture, and formation of paravertebral callus are unique radiological features of KD and could be used for differentiation of KD from acute OVCF with IVC.