Catastrophic intramedullary hematoma following Kümmell's disease with large intravertebral cleft

Background context: Kümmell'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. Purpose: The authors report unique experience with patients who presented with a catastrophic intramedullary hematoma after early stage Kümmell's disease without kyphosis. Study design: Case report with analysis of the literature. Methods: A 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. Results: The 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. Conclusions: An 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.