Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

Abstract

Delayed post-traumatic osteonecrosis, also known by its eponym Kummell's disease, is a rarely reported clinical entity that likely occurs with higher frequency than recognized. We highlight a case of a 75-year-old female household ambulator who presented with significant thoracolumbar pain and delayed T12 collapse after a groundlevel fall. The patient had sustained a trivial fall at home

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

“…A synovial-lined membrane secreting synovial fluid might later envelope this degeneration cavity [30]. Regarding the intravertebral vacuum phenomenon, some authors think it is the result of vertebral ON [15,16,31], whereas some believe that it signifies nonunion and pseudoarthrosis [32,33]. Lafforgue et al [34] argued that the intravertebral vacuum phenomenon could simply be a result of the migration of an intradiscal gaseous collection through a fractured endplate of an osteoporotic collapse.…”

“…The majority of these fractures heals uneventfully with conservative treatment with a mild backache as a residual. However, some of these patients continue to experience pain or neurological deficits: some of them may have developed delayed posttraumatic osteonecrosis [4][5][6]. The understanding of the natural history of vertebral fracture remains challenging because the healing potential is influenced by a variety of biochemical, biomechanical, cellular, and pathological mechanisms [7].…”

Pain reduction following vertebroplasty and kyphoplasty

“…For OVCFs patients with neurological symptoms, decompression, improvement of kyphosis, and spinal stabilization are the primary indications for surgery [14,15]. For most patients without neurological symptoms, vertebroplasty or kyphoplasty is an ideal choice.…”

Expert’s comment concerning Grand Rounds case entitled “Kümmell’s disease: delayed post-traumatic osteonecrosis of the vertebral body” (by R. Ma, R. Chow, F. H. Shen)

“…In the present issue, R. Ma et al report a case of Kümmell disease in a 75-year-old woman who experienced a delayed T12 vertebral collapse, after a ground level fall [1]. Kümmell described, in 1891, a ''postraumatic osteitis'' characterized by a painful kyphosis developing several months or years following an injury, after a symptom-free period [2].…”

“…Therefore, an osteoporotic fracture complicated by impaired healing and secondary osteonecrosis is a more likely explanation to both the Kümmell disease and the vertebral vacuum phenomenon [7]. In the Grand Rounds case report of Ma et al, the delayed post-traumatic vertebral fracture obviously belongs to a cascade of osteoporotic vertebral collapses [1]. Interestingly, Ma et al cautiously called their case ''delayed post-traumatic osteonecrosis'' without adopting the term of ''avascular osteonecrosis'' quoted by most authors [1].…”