Chronic Spinal Epidural Hematoma Related to Kummell's Disease

Abstract

An 82-year-old woman complained of severe back pain after a slight fall seven weeks earlier. She was transferred from a traditional oriental hospital to the emergency room of our hospital. Here, the patient was managed conservatively for multi-lev-J Korean Neurosurg Soc 49 : 231-233, 2011 10.3340/jkns.2011.49.4.231 Copyright © 2011 The Korean Neurosurgical Society Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

“…25 The main symptoms of Kümmell's disease are back pain with or without spinal cord injury. 26,27 The disease progresses progressively, and due to the obvious vertebral body necrosis and collapse, it can lead to severe kyphotic deformity in the late stage, which has a higher incidence of nerve injury than common OVCF. 28,29 Li et al divided Kümmell's disease into three stages: in Stage I, vertebral body height reduction was < 20% without adjacent disc degeneration; in Stage II, vertebral body height reduction was > 20%, often with adjacent disc degeneration; in Stage III, the posterior cortex of vertebrae ruptured with spinal cord compression.…”

Percutaneous vertebroplasty in osteoporotic vertebral compression fracture with huge spinal epidural hematoma

“…Moreover, intravertebral stability after PVP might have played a role in spontaneous resolution of SEH. [9] 81 Male T6 Dorsal; T6 level Normal PVP only Unknown Kim [10] 82 Female L1 Ventral; L1-L3 Normal PVP only Complete resolution of SEH at 3 days after PVP Kang [11] 79 Female T11 Dorsal; T10-L2 Progressive motor weakness and paresthesia of both lower limbs Emergent decompressive laminectomy and PVP Neurologic deficits improved Hirata [12] 73…”

“…However, they did not describe the mechanism, treatment strategies, and prognosis of the SEH. We searched the literature in 4 electronic databases including PubMed (https://pubmed.ncbi.nlm.nih.gov/), EMBASE (https://www.embase.com), Scopus (https://www.scopus.com/home.uri), Web of Science (www.webofknowledge.com/), and ProQuest (https://www.proquest.com/) from January 1990 to December 2020, but only 4 articles on 4 cases were identified [9–12] (Table 1). We report a further case of acute OVCF accompanying SEH managed successfully with simple PVP.…”

“…[ 14 , 15 ] The exact pathophysiological mechanisms underlying OVCF accompanying SEH is still not clear. Kim et al [ 10 ] and Hirata et al [ 12 ] theorized that the instability of the fracture was a cause of hematoma. They suspected that the fluid including the hemorrhage inside of the intravertebral cleft may be under pressure, and be pushed out into the epidural space during daily motion, and cause a subacute or chronic SEH.…”

“…Kang et al [ 11 ] performed emergent decompressive laminectomy due to the progressive motor weakness and paresthesia of both lower limbs. Kim et al [ 10 ] reported a case of chronic SEH related to Kummell disease. They suspected that the continuous instability might have prevented the spontaneous resolution of hematoma.…”