Kummel Disease

Introduction

Kummel disease was first described by Hermann Kummell in 1891 as delayed posttraumatic vertebral collapse occurring weeks or months after an often minimal injury. The mechanism is still debated. These lesions are most widely believed to be secondary to delayed osteonecrosis of the vertebral body, potentially related to vascular disruption of the anterior watershed territory of the vertebral body following trauma. It is a rarely reported entity, which likely occurs more frequently than recognized. Typically, only one vertebral level is involved within the lower thoracic or upper lumbar spine. Kummel disease most commonly affects middle-age or elderly patients. Unlike the more commonly seen osteoporotic compression fracture, delayed vertebral osteonecrosis (Kummel disease) has a typical clinical and radiographic course. The imaging finding of the “intravertebral vacuum cleft” ( Fig. 25.1 ) has been described on plain film, computed tomography (CT), and magnetic resonance (MR) imaging. Although vertebral clefts are often associated with Kummel disease, the finding is not exclusive to this disease process.