Presentation
Back pain with bilateral paraparesis of 3 weeks duration and no history of trauma.
Patient Data
Lateral view of lumbar spine reveals D12 wedge fracture with retropulsed fragment and air bubbles seen beneath its superior end plate. Intradiscal air is also noted at D11-D12 and L5-S1 discs (vacuum phenomenon).
CT confirms radiographic findings and reveals D12 anterior wedge fracture with retropulsion that compresses the distal cord against the posterior neural arch as well as D12 intravertebral air bubbles. There is generalized osteopenia of vertebral bodies however D12 vertebral body shows increased density. Also D11-D12 and L5-S1 intradiscal air bubbles are seen.
Case Discussion
Kümmell disease or vertebral osteonecrosis can be diagnosed by x-ray or CT by presence of intravertebral gas bubbles. MRI can diagnose the condition earlier by identifying a fluid-filled cavity within the vertebral body. Risk factors include osteoporosis, steroid therapy and irradiation.
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