Wedge-Compression Fractures

FACTS

 

HPI

 

PHYSICAL EXAM

IMAGING

 
A/P

Kummell Disease

  • delayed post-traumatic vertebral collapse representing osteonecrosis, occurs due to traumatic blood supply compromise → avascular necrosis
  • clinically the presentation is: mild back pain from the compression fractures → feels better as heals → osteonecrosis produces significant pain
  • imaging: intravertebral vacuum cleft sign = gas-filled cleft
 
  • It usually occurs weeks to months after a minor spinal injury that initially seemed insignificant.
  • The condition involves avascular necrosis of a vertebral body (most often in the thoracolumbar spine).
  • Patients may first experience mild back pain that improves, but then later develop progressive pain, spinal deformity (kyphosis), and sometimes neurological deficits due to collapse of the vertebra.
  • On imaging, a delayed collapse is seen; sometimes the “intravertebral vacuum cleft sign” (a gas-filled cleft within the collapsed vertebra on X-ray/CT) is considered characteristic.

Pathophysiology

  • After the trauma, blood supply to the vertebral body is compromised.
  • This leads to ischemic necrosis, weakening the bone structure.
  • Over time, the weakened vertebra collapses under normal axial loading.

Risk Factors

  • More common in older adults, especially those with osteoporosis.
  • Even minor trauma (like a fall from standing height) can precipitate it.

Management

  • Conservative treatment: analgesics, bracing, osteoporosis management if symptoms are mild and stable.
  • Interventions: vertebroplasty/kyphoplasty can help stabilize and relieve pain.
  • Surgery: indicated in cases with severe collapse, progressive kyphosis, or neurological deficits (instrumented fusion, decompression).