WINNING OVER AN
UNSTABLE SPINE

A rare case of a 77-year-old woman
with Kummell’s Disease

A 77 year-old woman with a past medical history of Diabetes Mellitus with coexisting hypothyroidism was brought to BLK Super Speciality Hospital approximately 5 months after experiencing a minor fall at home. Initially, her only complaints were an inconsistent, non-radiating pain in her mid-back. The pain worsened in intensity and frequency over time and was refractory to common analgesics. Progressively the worsening back pain started limiting her ability to walk. By about 5 months she was bed-ridden, predominately because of severe intractable pain. She also described some numbness in her back and legs, but did not have any neurological involvement.

Upon examination, the patient's VAS score was noted to be 8/10 and she was found to have more than 4 /5 power in her lower extremities. Stretch reflexes were normal and plantar responses were down-going. She was subjected to



MRI examination on clinical suspicion of Vertebral Compression Fracture (VCF). MRI revealed an L1 fracture with intra-vertebral vaccum cleft. T2 W1 MRI images revealed linear hyperintensity which was corroborated with T1 W1 hypointensity (air). There was also an associated fluid collection.



After the clinico-radiological establishment of diagnosis, the patient underwent transpedicular biopsy and Balloon Kyphoplasty. Post-operatively, the patient was made to stand and walk the same evening along with a brace. Her VAS score dropped remarkably from 8/10 to 2/10. She found dramatic relief from pain and her ability to walk was restored immediately. Biopsy revealed a trabecular bone pattern (no pathological lesion). The patient was put on anti-osteoporotic anabolic treatment (inj. teriparatide) along with calcium and Vitamin D supplements so as to minimise her chances of similar fracture in future

Dr. Puneet Girdhar
Director – Orthopaedics
Spine Surgery
BLK Institute for Bone,
Joint Replacement, Orthopaedics Spine and Sports
Medicine
BLK Super Speciality
Hospital, New Delhi

Dr. Bhupendra Bharti
Consultant – Orthopaedics Spine Surgery
BLK Institute for Bone,
Joint Replacement, Orthopaedics Spine and Sports
Medicine
BLK Super Speciality
Hospital, New Delhi

1