Impending cauda equina syndrome due to Kummell disease; A case report and literature review. (June 2021)

• Record Type: Journal Article
• Authors: Omidi-Kashani, Farzad; Parsa, Ali; Madarshahian, Daniel
• Is Part Of: International journal of surgery case reports. Volume 83(2021)
• Publication Date: 2021-06
• Subjects: Kummell disease -- Vertebral fracture -- Vertebral osteonecrosis -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106041
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Kummell 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. Importance: As an important but rare cause of non-discogenic cauda equina syndrome. Case presentation: Here, 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. Conclusion: KD 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: A case of Kummell disease in a rare location (L5 vertebra) was reported. The usual consequence of this disease is a compression fracture in a neurologically intact patient. In our case, the creation of a burst fracture induced cauda equina syndrome. This case represents a rare cause of non-discogenic cauda equina syndrome. Our patient unlike most individuals with Kummell disease, due to significant neurologic deficit needed open surgery.