Impending cauda equina syndrome due to Kummell disease; A case report and literature review.

Farzad Omidi-Kashani,Ali Parsa,Daniel Madarshahian

doi:10.1016/j.ijscr.2021.106041

Abstract

IntroductionKummell disease (KD) is a rare cause of vertebral fracture due to osteonecrosis. The natural history of the disease is characterized by a previous minor trauma, a subclinical window period, and then a symptomatic period presenting with disabling pain, kyphosis, or neurologic deficit.ImportanceAs an important but rare cause of non-discogenic cauda equina syndrome.Case presentationHere, we report on a wheelchair-bound 28-years-old bodybuilder man with KD who presented with progressive paresthesia and weakness of both legs (impending cauda equina syndrome) due to L5 involvement. He had a past medical history of arbitrary use of licensed and unlicensed drugs in the fitness field. The patient underwent posterior decompression, spinopelvic stabilization, and fusion. Postoperative rehabilitation was satisfactory and after six months, the leg muscle strength returned to normal and the patient's back pain disappeared.ConclusionKD should be considered as a rare differential diagnosis when dealing with any patient with a vertebral fracture associated with a history of minor trauma and an asymptomatic window period.

Highlights

Kummell disease (KD) is a rare cause of vertebral fracture due to osteonecrosis, but there is no consensus that the etiology of KD is the same as that of femoral head avascular osteonecrosis [1]
The natural history of the disease can be best characterized by a previous minor trauma, a subclinical window period, and a symptomatic period at which it manifests itself as a progressive disabling pain, kyphosis, or neurologic deficit [2,3]
We reported a case of a 28 years-old man with KD who presented to us with impending cauda equina syndrome due to L5 involvement which is extremely rare in this disease [12]

Summary

Introduction

Kummell disease (KD) is a rare cause of vertebral fracture due to osteonecrosis, but there is no consensus that the etiology of KD is the same as that of femoral head avascular osteonecrosis [1]. The natural history of the disease can be best characterized by a previous minor trauma, a subclinical window period, and a symptomatic period at which it manifests itself as a progressive disabling pain, kyphosis, or neurologic deficit [2,3]. We reported a case of a 28 years-old man with KD who presented to us with impending cauda equina syndrome due to L5 involvement which is extremely rare in this disease [12]. This case report has been reported in line with the SCARE Criteria [16]

Case presentation

Discussion

Conclusion