Case report of Kummell’s disease with delayed onset myelopathy and the literature review

• Published in: European journal of orthopaedic surgery & traumatology 2018-02, Vol.28 (2), p.309-316
• Main Authors: D’Oria, Salvatore, Delvecchio, Carlo, Dibenedetto, Mariagrazia, Zizza, Francesco, Somma, Carlo
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Case reports; Delayed Diagnosis; Disease; Fractures; Fractures, Compression - complications; Fractures, Compression - diagnostic imaging; General Review • SPINE - FRACTURES; Humans; Kyphosis - etiology; Literature reviews; Male; Medicine; Medicine & Public Health; Osteonecrosis - diagnostic imaging; Osteonecrosis - etiology; Osteonecrosis - surgery; Osteoporosis; Pain; Pathology; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - etiology; Spinal Cord Diseases - surgery; Spinal Fractures - complications; Spinal Fractures - diagnostic imaging; Surgical Orthopedics; Thoracic Vertebrae - injuries; Time Factors; Trauma; Traumatic Surgery; Vertebrae
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-017-2039-0

Introduction Kummell’s disease is an avascular necrosis of the vertebral body, secondary to a vertebral compression fracture. This entity is characterised by the gradual development in time of a vertebral body collapse following a trivial spinal trauma, involving a worsening back pain associated with a progressive kyphosis. Purposes The aim of this article is to carry out an international literature review regarding Kummell’s disease, addressing its physiopathology, histopathology, clinical presentation, radiological characteristics and treatment modalities; at the same time, the literature is updated through the description of a new and interesting case, symbol of the pathology long-term potential complications, if not diagnosed and therefore not suitably treated. Case report A patient with osteoporosis, following a slight spinal trauma, suffered a progressive necrosis of the D11 body; although the radiological exams showed a constant worsening of the thoracic-lumbar kyphosis and a restriction of the spinal canal, in another medical centre he was only treated with a corset and painkillers. A year after the injury, motor deficits concerning the lower limbs appeared. He was then sent to us and indication for posterior internal fixation was given. On the basis of both his medical history and radiological and histological findings, Kummell’s disease was diagnosed. Conclusion It is necessary to have a complete knowledge of the clinical, pathological and radiological characteristics of Kummell’s disease, so as to follow a correct diagnostic course enabling to prepare the most suitable therapy.