Strategies in the Management of Osteoporotic Kummell's Disease

Kummell disease is a condition characterized by severe pain, progressing kyphosis with or without neurological deficit following a trivial trauma in the old age osteoporotic population. It is an osteoporotic vertebral fracture due to avascular necrosis of the vertebra, having an asymptomatic period initially followed by progressive pain, kyphosis, and neurologic deficit. Although various management options are available for Kummell's disease, a dilemma occurs in selecting an optimal modality in each case.

A 65-year-old female presented with complaints of low back pain for 4 weeks. She developed progressive weakness and bowel bladder disturbance. Radiographs showed a D12 vertebral compression fracture with an intravertebral vacuum cleft sign. Magnetic resonance imaging showed intravertebral fluid and significant compression of the cord. We performed posterior decompression, stabilization, and transpedicular bone grafting at the D12 level. Histopathology confirmed Kummell's disease. The patient recovered with restored power and bladder control and resumed independent ambulation.

Osteoporotic compression fractures are more prone to pseudoarthrosis due to poor vascular and mechanical support, they need adequate immobilization and bracing. Transpedicular bone grafting for kummels disease seems to be a good surgical option due to its short operating time, less bleeding, less invasive approach, and early recovery. However, a treatment-oriented classification is needed to treat this clinical entity on a case-by-case basis.