Magnetic Resonance Imaging Negative Spine Trauma Followed by a Delayed Intravertebral Vacuum Cleft-Kümmell's Disease: A Case Report and Literature Review.

Background: Kümmell's disease (KD) is a rare clinical entity characterized by delayed post-traumatic vertebral body collapse, in which an intravertebral vacuum cleft (IVC) is formed. The patient sustained a minor spinal trauma, and their spine X-ray examinations were negative. However, after an asymptomatic period of months, they developed recurrent back pain because of the progressive vertebral collapse of the affected spine. However, no imaging examination could confirm the magnetic resonance imaging (MRI)-negative initial spinal trauma followed by delayed vertebral collapse with IVC.

Case Presentation: We report a case of KD occurring in a 66-year-old postmenopausal patient whose lumbar MRI on sagittal planes were immediately performed following the initial trauma (a ground-level fall) and revealed that the vertebral integrity or connectivity was not interrupted and the marrow signal was even. After an asymptomatic period of 8 months, the back pain reappeared and progressively exacerbated. The wedge-shaped change in the T11 vertebra with an IVC was confirmed by lumbar computed tomography and MRI. Finally, KD was diagnosed following extensive routine hematological and biochemical workups. Percutaneous kyphoplasty was performed to relieve her back pain by restoring her vertebral stability.

Conclusions: We confirmed that the OVF was not the first step in the KD sequence, and the IVC - KD - could from an initial MRI-negative spine trauma.