Kummell's disease was first described by Kummell in 1895, who reported a series of patients presenting with delayed vertebral collapse after seemingly minor trauma

1. Dr Tejasvi Agarwal
KUMMEL’S DISEASE

2.  Kummell's disease was first described by
Kummell in 1895, who reported a series of
patients presenting with delayed vertebral
collapse after seemingly minor trauma.
 Kummell's disease is most prevalent in
middle-aged and older patients.
 Incidence - 7% to 37%.

3.  A series of five clinical stages have been
described for this condition:
1. After the initial trauma, there is back pain while the
radiographic and CT studies are negative.
2. Then follows a period of minor symptoms that don't
interfere with daily activities.
3. The third stage is a period of general well-being,
completely asymptomatic or with minor symptoms,
with its duration ranging from 4 weeks to 1 year.

4. 4. In the fourth stage there is recurrence of back
pain, with possible development of nerve root
compression and its associated peripheral pain.
5. Finally, there is kyphotic spine deformity caused
by vertebral collapse and possible neurological
impairment, with variable degrees of paraesthesia,
muscle weakness and loss of sphincter control.

5.  Avascular necrosis of the vertebral body after a
vertebral compression fracture.
 Represents a failure of the fracture healing process
after a minor traumatic injury.
 Risk factors - chronic steroid use, osteoporosis,
alcoholism and radiation therapy
 Pathology - An avascular zone develops below the
superior endplate, eliminating healing potential and
resulting in an atrophic or avascular nonunion.

6. Presentation:
 Back pain, often acute or chronic at onset, with or
without neurogenic claudication in a patient with
known osteoporosis
 Presents as vertebral osteonecrosis typically
affecting a thoracic vertebra with compression
deformity,
 Intravertebral vacuum cleft, and exaggerated
kyphosis weeks to months after a minor traumatic
injury.

7. Flexion, the fracture compresses through the avascular
zone directly beneath the superior endplate, demonstrating
the maximal degree of height loss, but in extension, the
fracture plane gaps open (A and B)

8. This motion (pseud-
arthrosis) is
responsible for the
vacuum effect, which
pulls transudative fluid
and nitrogen gas(white
arrow, C) into the
fracture site.

9.  Intervertebral gas is a
radiographic and CT
finding indicative of
Kummel disease. In this
case, the fluid and gas
escaped from the fracture
and descended along the
right psoas muscles,
creating the false
appearance of a psoas
abscess (D).
 Confirming this
explanation of the fluid
collection over the right
psoas, the fluid
collection is benign in
appearance; there is no
associated soft-tissue
edema on T2 magnetic
resonance images (MRIs)
(E).

10. The most important finding on
the MRI is that the adjacent level
endplates and vertebral bodies
(L2 and L4) are completely
normal. Spondylodiscitis or
vertebral osteomyelitis would
have destroyed and/or inflamed
the adjacent disk spaces and
endplates.

11.  The pathopneumonic
finding in this sequence
of images, is the
intervertebral gas,
pseudarthrosis and lack
of adjacent inflammation.
 The postoperative sagittal
CT-recon image shows
the results of open
kyphoplasty, with
laminectomy (note that
the L3 spinous process is
absent) and improvement
in L3 vertebral height (G).

12. Initial CT
scan
Case 1

13. CT scan- 5 months later

14. Axial view at the level of the vertebral body,
showing intravertebral vacuum cleft (arrow).

15. CT images of Kummel’s disease. (a) Sagittal and (b) coronal images of the
thoracic spine
show marked anterior compression deformities of the T8 and T9 vertebral bodies
(solid arrows) with intravertebral vacuum clefts (dashed arrows) compatible with

16. Sagittal MR images of a patient with Kummel’s disease: (a) T2-weighted, (b) T1-
weighted, and (c) STIR (short TI inversion recovery). Images show anterior
compression deformities (solid arrows).
The T2-weighted and STIR images show a classic “double line” sign of low-
intensity vacuum cleft surrounded by elevated signal from edema (dashed arrow).
The T1-weighted image shows the absence of signal within the vertebral body
vacuum clefts (dashed arrow).

17. Treament :
 Neurologic compromise is more common with KD
than with osteoporotic compression fractures.
 Treatment of KD is designed to eliminate motion
at the fracture site and to relieve neurologic
symptoms.
 The preferred treatment(Conservative vs
Surgical) method rests on three factors: the
patient’s subjective pain level, the degree of
kyphotic deformity, and specific neurologic
deficits.

18.  Vertebroplasty or Kyphoplasty: has shown
favorable results and is successful at alleviating
back pain, but surgical intervention is often
indicated, especially in the presence of
neurologic compromise.
 Surgical decompression and fusion can be
obtained from anterior, posterior, or combined
approaches, with the goal of restoring near-
anatomic sagittal alignment and eliminating
pathologic motion.

19. Differential Diagnosis
 Infectious osteonecrosis,
 Degenerative vertebral body fracture,
 Neoplastic vertebral body fracture,
 Ischemic osteonecrosis.

20. Thank you