Lee Sun-Ho, Cho Dae-Chul, Sung Joo-Kyung
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, 700-721, Republic of Korea.
Spine J. 2008 Nov-Dec;8(6):1007-10. doi: 10.1016/j.spinee.2007.07.397. Epub 2007 Nov 26.
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.
The authors report unique experience with patients who presented with a catastrophic intramedullary hematoma after early stage Kümmell's disease without kyphosis.
Case report with analysis of the literature.
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.
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.
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.
Kümmell病被定义为缺血性骨坏死，发生于创伤后延迟性椎体塌陷。除了晚期伴有后凸畸形和后皮质破裂的病例外，Kümmell病导致的严重脊髓损伤很少见。
作者报告了早期无后凸畸形的Kümmell病患者出现灾难性髓内血肿的独特经验。
病例报告并结合文献分析。
一名72岁患有T12骨质疏松性椎体骨折的女性因持续背痛和双下肢轻瘫就诊于急诊室。X线平片检查显示轻度骨质疏松性楔形压缩骨折。磁共振成像显示骨折腔为异常低信号和高信号的离散区域，这与T12椎体缺血性坏死及Kümmell病相符，圆锥显示广泛血肿并伴有混合信号改变。
作者实施了椎板切除术并清除髓内血肿，随后对T12进行椎体成形术。采用一期手术，通过椎弓根螺钉系统对脊柱进行复位和后路固定。
提高对骨质疏松性脊柱骨折后延迟性椎体塌陷伴脊髓损伤的认识，以及定期随访和治疗对于预防灾难性神经功能障碍至关重要。
