Catastrophic intramedullary hematoma following Kümmell's disease with large intravertebral cleft |
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| Institution: | 1. Grand Rapids Medical Education Partners, 1000 Monroe Ave NW, Grand Rapids, MI 48195, USA;2. Department of Surgery, BG-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany;3. Department of Orthopaedic Surgery, Orthopaedic Associates of Michigan, Michigan State University, 230 Michigan St NE, Suite 300, Grand Rapids, MI 49503, USA;4. Department of Surgery, Michigan State University, Grand Rapids, 230 Michigan St NE, Suite 300, MI 49503, USA;1. Department of Neurosurgery, CN Center, Ansari Nagar, All India Institute of Medical Sciences (AIIMS), New Delhi, India;2. Department of Neuroradiology, CN Center, Ansari Nagar, All India Institute of Medical Sciences (AIIMS), New Delhi, India;3. Department of Neuropathology, CN Center, Ansari Nagar, All India Institute of Medical Sciences (AIIMS), New Delhi, India;1. Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Rd, Wenzhou, Zhejiang 325000, China;2. Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefeng Road, Hangzhou, 310009, China;1. Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain;2. Department of Gastroenterology, Hospital Universitario de La Princesa, and Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain;3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain;4. Department of Gastroenterology, Hospital Clínico Universitario San Carlos, Madrid, Spain;5. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain;6. Department of Microbiology, Hospital Universitario de Fuenlabrada, Madrid, Spain;1. California Spine, 711 West College Street, Suite 625, Los Angeles, CA 90012, USA;2. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 711 West College Street, Suite 625, Los Angeles, CA 90012, USA;3. Department of Plastic and Reconstructive Surgery, White Memorial Medical Center, 1720 East Cesar Chavez Avenue, Los Angeles, CA 90033, USA;4. Department of Pathology, College of Medicine, State University of New York, Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA |
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| Abstract: | Background contextKümmell's disease is defined as avascular osteonecrosis and occurs after delayed posttraumatic vertebral collapse. Devastating cord injury with Kümmell's disease is rare except in advanced cases with kyphosis and posterior cortex breakage.PurposeThe authors report unique experience with patients who presented with a catastrophic intramedullary hematoma after early stage Kümmell's disease without kyphosis.Study designCase report with analysis of the literature.MethodsA 72-year-old woman with osteoporotic vertebral fractures of T12 visited the emergency room complaining of persistent back pain and paraparesis. The plain radiographic examination revealed mild osteoporotic wedge compression fractures. The magnetic resonance images revealed the fracture cavity as a discrete area of abnormal low and high signal, which is consistent with vertebral osteonecrosis with evidence of Kümmell's disease on T12, and conus showing an extensive hematoma with mixed signal changes.ResultsThe authors performed laminectomy and the removal of the intramedullary hematoma, followed by vertebroplasty on T12. The spinal column was reduced and fixed posteriorly with a pedicle screw system using a one-stage procedure.ConclusionsAn increasing awareness of the delayed vertebral collapse with cord injury attached to an osteoporotic spine fracture, as well as a periodic follow-up and treatment are essential for preventing catastrophic neurological impairment. |
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