Spontaneous Air Reduction of Vertebra Plana with Kummell's Disease During Vertebroplasty: Subsequent Experience with an Intentional Trial

Dear Editor, Kummell's disease, known as the delayed posttraumatic osteonecrosis of the vertebral body, is characterized by a vertebral compression fracture with osteonecrosis. Necrotic changes cause air or fluid collection in the fractured vertebra, which shows a pathognomonic radiologic finding “intravertebral vacuum cleft” [1]. Vertebral augmentation procedures, such as vertebroplasty (VP) and kyphoplasty (KP), are well known to be effective in managing vertebral compression fractures [2]. However, vertebra plana, meaning severe or complete vertebral body collapse, is a relatively contraindication for these procedures because of technical difficulty and the increased risk of bone cement leakage [3]. In this letter, we present an intentional trial of spontaneous reduction of vertebra plana with Kummell's disease. This procedure was performed after we encountered an accidental air reduction when a bone access cannula advanced into the intravertebral vacuum cleft [4]. A 73-year-old woman presented at our pain clinic complaining of aggravating low back pain for a duration of 1 week (visual analog scale [VAS] was more than 7/10) that was made worse while sitting or walking. One year ago, an episode of low back pain (VAS was 4) occurred after the patient lifted a heavy object, and she was treated with oral nonsteroidal …