Percutaneous Transpedicular Fixation with Cemented Screws – A Surgical Hypothesis for Kummel’s Disease

Abstract

Introduction: The majority of compression fractures is stable and treated without major complications. One of the possible late consequences after trauma is the so called vertebral body avascular necrosis, also known as Kummel’s disease. This entity is clinically characterized by a progressively painful kyphosis within months after a minor trauma. The incidence of this finding is difficult to accurately precise because many designations have been used to describe it and it has been over diagnosed in many patients who don´t follow all the inclusion criteria. Clinical case: This paper presents the case of a 63-year-old female, with a background of Psoriatic Arthritis under biological treatment. She confirmed having a minor dorsolumbar trauma in the beginning of 2011, at the time without any complaints or new onset of pain. Five years after the trauma she came to the Emergency Room with back pain limiting her daily life. X-rays and a Computerized Tomography (CT) were taken and showed classical signs compatible with Kummel’s disease. It was suggested surgical treatment, accepted by the patient and in February 17th 2016 she was submitted to a percutaneous transpedicular fixation from D10 to L4, with cemented screws. She had a favorable outcome with clinical and radiological signs of bone consolidation Conclusion: Kummel’s disease is an exclusion diagnosis. There are clinical and imagiological criteria to help define this disease. Treatment consists of surgical fixation with anterior, posterior and both anterior/posterior approaches still being discussed on which of these gives the best results.