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Vertebral Body Avascular Necrosis Resulting in Spinal Cord Injury 2005

General Spine

Jamie L Baisden, MD
Guillermo Carrera , MD, ASSR Member
Brain Bunch , MD, Non ASSR Member
Kim Rickert , MD, Non ASSR Member
Vladimir Osipov , MD, Non ASSR Member

Excerpta

Aseptic vertebral body osteonecrosis or Kummell-Verneuli's disease is an uncommon entity. Spinal cord injury attributed to Kummell's disease is even more rare. Kummel's disease is more commonly a radiographic diagnosis based on collapse or flattening of one or more vertebrae with associated intravertebral vacuum cleft. It is often associated with severe osteoporosis, chronic long-term corticosteroid therapy, and a history of trauma. Nontraumatic vertebral collapse is often more commonly associated with malignancy or osteomyelitis.

We present a case of a 77 yo afroamerican female who presented with pectoral and epigastric chest pain neurologically intact. A helical CT demonstrated an acute pulmonary embolosm and a destructive lesion of the T6 vertebrae. The patient developed a rapidly progressive paraparesis resulting in complete T6 pareplegia within 3 days of the initial CT. Metastatic workup included spinal MRI, CT, plain films, bone scan, CXR,laboratory studies, and a CT of the chest abdomen and pelvis. Only the T6 osteolytic lesion with adjacent pre- and paravertebral reactive tissue was identified. CT-directed needle biopsy was nondiagnostic. Cultures revealed no growth. Thoracic laminectomy and open biopsy provided pathologic conformation of vertebral osteonecrosis with no evidence of malignancy.

We present this case to review the radiologic and pathologic findings of vertebral osteonecrosis resulting in spinal cord injury.

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