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Never visited LATERAL HEMIVERTEBRA OF L4 WITH ASSOCIATED DISC HERNIATIONS
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 34 year old female
History:

Rule out lumbar disc herniation.

Images:[small]larger

Fig. 1: AP L-SPINE

Fig. 2: AP L-SPINE SPOT

Fig. 3: LATERAL L-SPINE

Fig. 4: LATERAL L-SPINE SPOT
Findings:

MRI examination of the lumbar spine reveals the following:


L5-S1: There is mild loss of disc height with a broad-based left paramedian and far lateral protrusion measuring 4-5 mm with associated endplate spondylosis and reactive Modic II changes. This creates prominent left IVF stenosis compressing upon the exiting L5 nerve root and dorsal root ganglion. There is mild compression upon the thecal sac and traversing left S1 nerve root.


L4-L5: There is a scoliotic deformity of the L4 vertebral body attributed to a partial lateral hemivertebra which correlates the x-ray examination. This is clearly seen on coronal images 5-8. This deformity has created prominent loss of disc height and desiccation of nucleus pulposus with left lateral listhesis of 4-5 mm and associated prominent left lateral stenosis of the lateral recess and neural foramen. There is compression upon the traversing L5 and exiting L4 nerve roots. Clinical correlation advised for respective radicular involvement.


L3-L4: There is moderate signal loss of its nucleus pulposus, mild loss of disc height, concentric annular bulging and mild distortion from the scoliotic deformity of the L4 hemivertebra as visualized.

The remaining intervertebral discs of the lumbar spine are well maintained. The vertebral bodies do not show any compression fractures or aggressive osseous lesions. Posterior elements of the lumbar spine do show hypertrophic atypical morphology, especially at L3-L4 and L4-L5 on the right attributed to the hemivertebra congenital deformity. These changes enhance the lateral recess and neural foraminal stenosis at L4-L5 and L5-

S1. The conus medullaris is unremarkable. The retroperitoneal structures visualized in this exam are within normal limits.

XRAY:

X-ray examination reveals a lateral hemivertebra at the L4 vertebral body with under-development of the right lateral aspect. This creates secondary atypical morphology of the posterior elements at L3-L4 and L4-L5 with associated hypertrophic change. There is marked disc space narrowing L4-L5. A small focal structural left convex lumbar scoliotic deformity is present with its apex on the left side of the hemivertebra deformity. There are no acute compression fractures. There are no lytic or blastic bone lesions. Soft tissues do not show any abnormal masses or calcifications. Incidentally observed is hypoplasia of the right T12 rib.

Diagnosis:

MRI CONCLUSIONS:

1. BROAD-BASED LEFT POSTEROLATERAL AND FAR LATERAL PROTRUSION OF L5-S1 WITH ASSOCIATED ENDPLATE MODIC II CHANGES AND SPONDYLOSIS CREATING IVF STENOSIS AND COMPRESSING THE EXITING L5 NERVE ROOT AND DRG.

2. PARTIAL LATERAL HEMIVERTEBRA OF L4 WITH CORRESPONDING LEFT LATERAL LISTHESIS AND ASYMMETRICAL ANNULAR BULGING/SPONDYLOSIS CREATING STENOSIS OF THE LEFT NEURAL FORAMEN AND LEFT LATERAL RECESS. CLINICAL CORRELATION ADVISED FOR L5 AND/OR L4 RADICULAR INVOLVEMENT.

3. MILD DEGENERATIVE INTERVERTEBRAL OSTEOCHONDROSIS L3-L4 WITH MILD CONCENTRIC ANNULAR BULGING.

4. FACET HYPERTROPHY AND ATYPICAL MORPHOLOGY OF L3-L4, L4-L5 AND L5-S1 ATTRIBUTED TO THE CONGENITAL DEFORMITY OF THE L4 VERTEBRAL BODY.

XRAY CONCLUSIONS:

1. CONGENITAL HEMIVERTEBRA DEFORMITY OF THE L4 VERTEBRAL BODY AS DESCRIBED.

2. FOCAL LEFT CONVEX STRUCTURAL LUMBAR SCOLIOSIS APEXED AT L4 DUE TO THE HEMIVERTEBRA DEFORMITY. SCOLIOTIC DEFORMITY MEASURES APPROXIMATELY 20 DEGREES.

3. MARKED DISC SPACE NARROWING L4-L5.

References:

REFERRING PHYSICIAN: LESHA ROBERTS, DC

Comments:
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Additional Details:

Case Number: 13533506Last Updated: 2011-09-24
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional Radiograph, MRAccess Level: Readable by all users

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