Korean J Pain.  2011 Dec;24(4):231-234. 10.3344/kjp.2011.24.4.231.

Spontaneous Vertebral Reduction during the Procedure of Kyphoplasty in a Patient with Kummell's Disease

• Hur W
• Choi SS
• Lee M
• Lee DK
• Lee JJ
• Kim K

• KMID: 2074019
• DOI: http://doi.org/10.3344/kjp.2011.24.4.231

Abstract

Kummell's disease is a spinal disorder characterized by delayed post-traumatic collapse of a vertebral body with avascular necrosis. Although definitive treatment for Kummell's disease has not been established, it has been reported that percutaneous vertebroplasty or kyphoplasty has shown good results. However, these procedures are not recommended for severely collapsed vertebral bodies because of the risk of cement leakage or technical difficulties. Authors report a rare case of spontaneous reduction in vertebral height by the insertion of a working cannula into the vertebral body in Kummell's disease.

Keyword

compression fracture; kyphoplasty; osteoporosis

MeSH Terms

Catheters
Fractures, Compression
Humans
Kyphoplasty
Necrosis
Osteoporosis
Vertebroplasty

Figure

• 

  Fig. 1 Antero-posterior (A) and lateral (B) images of T-L spine plain radiography. They showed severe vertebral collapse with vertebral vacuum cleft (white arrow) at L1. Localized kyphosis in T-L junction, moderate to severe disc degeneration and generalized severe osteoporosis were also found.

• 

  Fig. 2 T1-weighted lumbar MR image showed low signal area, upper and lower endplate disruption, and prominent posterior bulging of fractured fragment in collapsed L1 vertebra.

• 

  Fig. 3 The lateral image of C-arm fluoroscopy during balloon kyphoplasty. There was the recovery of collapsed vertebral body, as working cannula advanced through the pedicle into the vertebral body.

• 

  Fig. 4 Postero-anterior image of C-arm fluoroscopy after completion of bone cement injection. No cement leakage out of vertebral body was found.

Reference

1. Van Eenenaam DP, el-Khoury GY. Delayed post-traumatic vertebral collapse (Kummell's disease): case report with serial radiographs, computed tomographic scans, and bone scans. Spine (Phila Pa 1976). 1993; 18:1236–1241. PMID: 8362333.

2. Young WF, Brown D, Kendler A, Clements D. Delayed post-traumatic osteonecrosis of a vertebral body (Kummell's disease). Acta Orthop Belg. 2002; 68:13–19. PMID: 11915453.

3. Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978; 129:23–29. PMID: 693884.

4. Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J. 2000; 9:445–450. PMID: 11057541.

5. Masala S, Fiori R, Massari F, Simonetti G. Kyphoplasty: indications, contraindications and technique. Radiol Med. 2005; 110:97–105. PMID: 16163144.

6. Masala S, Fiori R, Massari F, Cantonetti M, Postorino M, Simonetti G. Percutaneous kyphoplasty: indications and technique in the treatment of vertebral fractures from myeloma. Tumori. 2004; 90:22–26. PMID: 15143966.

7. McKiernan F, Jensen R, Faciszewski T. The dynamic mobility of vertebral compression fractures. J Bone Miner Res. 2003; 18:24–29. PMID: 12510802.

8. Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol. 2001; 22:373–381. PMID: 11156786.

9. Kempinsky WH, Morgan PP, Boniface WR. Osteoporotic kyphosis with paraplegia. Neurology. 1958; 8:181–186. PMID: 13517483.

10. Li KC, Li AF, Hsieh CH, Liao TH, Chen CH. Another option to treat Kümmell's disease with cord compression. Eur Spine J. 2007; 16:1479–1487. PMID: 16568304.

11. Choi YS, Lee MG, Lee HM, Jo JY, Jeong HJ, Lee CJ, et al. A case of balloon kyphoplasty in high risk under cement leakage: a case report. Korean J Pain. 2006; 19:261–265.