Impending cauda equina syndrome due to Kummell disease; A case report and literature review

Introduction: Kummell disease (KD) is a rare cause of vertebral fracture due to osteonecrosis. The natural history of the disease is characterized by a previous minor trauma, a subclinical window period, and then a symptomatic period presenting with disabling pain, kyphosis, or neurologic deficit. Importance: As an important but rare cause of non-discogenic cauda equina syndrome. Case presentation: Here, we report on a wheelchair-bound 28-years-old bodybuilder man with KD who presented with progressive paresthesia and weakness of both legs (impending cauda equina syndrome) due to L5 involvement. He had a past medical history of arbitrary use of licensed and unlicensed drugs in the fitness field. The patient underwent posterior decompression, spinopelvic stabilization, and fusion. Postoperative rehabilitation was satisfactory and after six months, the leg muscle strength returned to normal and the patient's back pain disappeared. Conclusion: KD should be considered as a rare differential diagnosis when dealing with any patient with a vertebral fracture associated with a history of minor trauma and an asymptomatic window period.