Delayed post-traumatic osteonecrosis, also known by its eponym Kummell's 
disease, is a rarely reported clinical entity that likely occurs with higher 
frequency than recognized. We highlight a case of a 75-year-old female household 
ambulator who presented with significant thoracolumbar pain and delayed T12 
collapse after a ground-level fall. The patient had sustained a trivial fall at 
home 4 months prior to this presentation and had been hospitalized in our 
institution at that time for a general medical workup. Dedicated spine 
radiographs were not obtained during this visit. However, lateral chest 
radiograph demonstrated an intact T12 vertebral body. The patient was able to 
mobilize successfully with therapy and was discharged home. During the interim 
between the initial fall and subsequent presentation, she resumed physical 
activity including ambulating independently and performing various housework. 
Approximately 4 months following her initial injury, the patient returned to a 
local emergency department with vague complaints of abdominal pain without any 
history of recent fall or injury. After an unremarkable workup, the patient was 
sent home. Ten days later, she represented to our institution's emergency room 
with worsening pain. Radiographs and CT scan demonstrated interval collapse of 
the T12 vertebral body. A linear vacuum cleft was noted on X-rays and CT. An 
extensive workup to exclude other processes such as malignancy or infection, 
which was negative, ensued. Delayed post-traumatic vertebral collapse was 
diagnosed. A trial of medical management and therapy was attempted, but she 
continued to experience significant pain. A T12 vertebroplasty was therefore 
offered and performed to stabilize the injury and to relieve the pain. She was 
subsequently able to be discharged from the hospital and transitioned back to 
home life. At approximately 2 years following her injury, the patient was noted 
to be able to ambulate with a walking aid. Her final radiograph after her 
surgery demonstrated that the T12 vertebroplasty had maintained its height and 
sagittal alignment. This Grand Round case highlights the clinical presentation 
of Kummell's disease. Aspects of the clinical entity that will be discussed 
include a historical review of the disease, hallmark radiographic findings and 
treatment options.