0:00

<v ->And finally in this segment, let us talk

0:04

about other disorders that seem

0:06

to link osteonecrosis,

0:09

traumatic fractures,

0:11

and insufficiency fractures.

0:13

You've heard of all these.

0:15

I'm gonna show you a few examples.

0:18

You probably have heard of Kummell disease.

0:20

I don't know if you have, maybe

0:22

you call it Kummell phenomenon.

0:24

This was described by Kummell in 1891,

0:28

and here I'm gonna quote him,

0:30

"Trauma frequently of minor degrees,

0:33

involving the spinal column directly

0:35

or indirectly, may subside in its effect

0:40

in a few days, or only to find out that

0:44

several months of apparently good health,

0:47

And then what occurs is the beginning

0:50

of back pain and rarefaction within

0:55

the vertebral bodies."

0:56

So what he was talking about was

0:59

delayed post traumatic collapse

1:02

of a vertebral body.

1:04

Now in those vertebral bodies he talked

1:06

about radiolucency, okay, but he didn't

1:11

use the term vacuum vertebral body.

1:15

Once again, we turned to Belgium, we turned

1:17

to the group of radiologists that occur there

1:20

that turn out spectacular work,

1:22

and they concentrated on this

1:26

vacuum vertebral body or cleft,

1:30

and it was their belief that although

1:33

Kummell had described it as a post

1:35

traumatic abnormality that they felt

1:38

that this was related to steroid use,

1:42

and that this was a Crescent sign,

1:45

a fracture through necrotic bone,

1:48

that we typically would see in the femoral head,

1:50

But now we were beginning to see

1:54

within the vertebral body in patients on steroids

1:58

and they introduced the term

2:00

vacuum vertebral body.

2:03

Well, I think there's probably multiple

2:05

causes of a vacuum vertebral body.

2:08

But think for a moment, if you are the

2:11

radiologist on call, a patient comes in

2:13

to the emergency room with back pain,

2:16

you get this radiograph, you see the

2:18

collapsed vertebral body, you have

2:21

a long list of possibilities

2:25

atop the list, things sinister,

2:27

like infection and tumor.

2:29

If you can find that vacuum vertebral body

2:33

here's where it would be, you can almost always

2:36

eliminate infection and tumor therein

2:40

lies the value. Yes, I've seen it in

2:43

a case of hemangioma and myeloma,

2:46

but generally you eliminate infection and tumor.

2:51

Now, whether it is a insufficiency fracture,

2:55

an area of osteonecrosis, we could argue

2:59

but it is not tumor or infection.

3:02

It is a great sign to know about.