Back Pain – Annoying but still very disabling painful medical condition. Back pain may cause an individual to be completely bedridden and unable to perform any activity either at home or work. Elderly patient often suffer with osteoporosis. Fall or blunt trauma to back often results in fracture of body of vertebrae. Such injury is often not diagnosed for prolonged period and known as Traumatic Spondylopathy or Kummel’s disease.1 In this article, we are going to discuss about a medical condition of the spine where a trivial trauma to the spine results in incapacitating back pain and that too lasting quite a significant time after the back injury. This condition is called Traumatic Spondylopathy or Kummel Disease.
How Do We Define Traumatic Traumatic Spondylopathy or Kummel Disease?
Traumatic spondylopathy or Kummel Disease is a disorder of the spine, which occurs as a result of some sort of injury to the spine. Symptoms may not appear immediately following injury but may be significant after few days. The disease came into existence about a century ago when it was noticed that people started getting disabled after sustaining what can be termed as a very minor injury to the spine. After months of virtually no symptoms, people started developing excruciating back pain and also started developing a spinal curvature also known as kyphosis. This was later termed as Traumatic Spondylopathy or Kummel Disease. This condition is very rare.
Stages of Traumatic Spondylopathy or Kummel Disease
There are generally five Stages to Traumatic Spondylopathy or Kummel Disease:
- Initial Injury: This can be any type of injury to the spine ranging from mild to moderate to severe. In this stage, x-rays show normal results.
- Posttraumatic Period: In this stage, the patient may start feeling some back pain but his/her functionality is not affected and he is able to perform his normal daily functions appropriately.
- Latent Stage: In this stage, the individual starts to feel mild pain but again the daily function is not affected.
- Recrudescent Stage: In this stage, the individual complains of severe and disabling back pain initially at the area of the injury but then it starts radiating to other parts.
- Terminal Stage: In this stage, the individual gets disabled and develops severe kyphosis of the spine.
Symptoms Of Traumatic Spondylopathy Or Kummel Disease
As stated above, during the initial phase of the injury, there are virtually no symptoms, but then gradually there is development of back pain, which gets severe over time. There is also development of a curvature of the spine associated with it. The symptoms generally start after about one year of the injury.
Diagnosis For Traumatic Spondylopathy Or Kummel Disease
At present, the diagnosis of Traumatic Spondylopathy or Kummel Disease is made by x-rays and MRI/CT scanning. The diagnosis is confirmed when the physician sees evidence on radiological studies of flattening of the spine and there is a vacuum in the space. Apart from this, there is no other confirmatory test to diagnose Traumatic Spondylopathy or Kummel Disease. It is generally a diagnosis of exclusion, which means Traumatic Spondylopathy is usually diagnosed after all other causes of back pain have been ruled out.
Treatment For Traumatic Spondylopathy or Kummel Disease
The treatment of Traumatic Spondylopathy or Kummel Disease is generally on a case-to-case basis. The physician will be taking into account the extent and severity of the initial injury, the current status of the patient, and what further damage can potentially be done.
Medications To Treat Traumatic Spondylopathy or Kummel Disease
- NSAIDs– Prescribed for initial pain caused by trauma.
- Opioids- If pain continues and all other treatment failed.
Physical Therapy (PT) To Treat Traumatic Spondylopathy or Kummel Disease
- Often most effective treatment, if initiated in early phase.
- Strengthening of back muscles and early improvement of back activities helps to reduce pain.
Interventional Pain Therapy To Treat Traumatic Spondylopathy or Kummel Disease
- Epidural corticosteroid injection- Repeated cortisone injection in epidural space helps to reduce or eliminate inflammation and reduce pain.
- Selective nerve root block- if pain is localized at any particular nerve, then selective nerve block using corticosteroid helps to relieve pain.
Surgery For Traumatic Spondylopathy or Kummel Disease
- Spinal Fusion
1. Kummel disease: a not-so-rare complication of osteoporotic vertebral compression fractures.
Freedman BA1, Heller JG.
J Am Board Fam Med. 2009 Jan-Feb;22(1):75-8. doi: 10.3122/jabfm.2009.01.080100.
2. Combination of Percutaneous Osteosynthesis and Vertebroplasty of Thoracolumbar Split Fractures Under CT and Fluoroscopy Guidance: A New Technique.
Amoretti N1, Huwart L.
Cardiovasc Intervent Radiol. 2014 Jan 31. [Epub ahead of print]