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previously visited ACUTE COMPRESSION WEDGE FRACTURE OF L3
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 15 year old female
History:

15 year old female with acute low back pain for 2 weeks.  Denies trauma...

Images:[small]larger

Fig. 1: T1 Sagittal MRI: Low signal T1 changes in marrow in addition to vertebral deformity is indicative of edema/inflammation in bone and marrow.

Fig. 2: T2 Saggitall MRI with fat suppression allows for clarity in seeing increase signal within fracture which is a T2 indication of edema/inflammation in bone and marrow.

Fig. 3: T2 Sagittal MRI without Fat Suppression. Edema/inflammation is not seen as well, but it does clearly delineate the fracture deformity.

Fig. 4: LATERAL LUMBAR

Fig. 5: AP LUMBAR

Fig. 6: LATERAL LUMBAR SPOT
Findings: X-RAY

X-ray examination of the lumbar spine reveals a relatively recent compression fracture/deformity of the L3 vertebral body with approximately 30-40% loss of anterior vertebral body height.There is no retropulsion of fragments into the spinal canal.The lumbar lordosis remains adequately aligned.There is no instability.There is no spondylolysis.Disc spacing is unremarkable.There is an accentuated lumbar lordosis.Sacrum and sacroiliac joints are within normal limits.The soft tissues do not show any abnormal masses or calcifications.

MRI

†MRI examination reveals acute compression wedge fracture of the L3 vertebral body with approximately 30 to 40% loss of vertebral body height.There is diffuse low signal T1, high signal T2 signal abnormality within the vertebral body indicating active edema and inflammation.Marked anterior cortical disruption secondary to the wedging is noted.There is no evidence of retropulsion fragments or hemorrhage into the spinal canal from the vertebral body.There are no disc herniations at L2-3 or L3-4.These intervertebral discs a the adjacent levels of the L3 vertebral body are unremarkable.The posterior elements of L3 and remaining lumbar spine do not show any spondylolysis or disruption of the middle or posterior columns.The remaining vertebral bodies are unremarkable.There is mild dorsal annular bulge of L5-S1, but the remaining intervertebral disc height and signal is adequate.There is mild facet hypertrophy also noted at L4-5.This may be attributed to the patientís accentuated lumbosacral angle.
Diagnosis:

ACUTE COMPRESSION WEDGE FRACTURE/DEFORMITY OF THE L3 VERTEBRAL BODY WITH APPROXIMATELY
30-40% LOSS OF ANTERIOR VERTEBRAL BODY HEIGHT.

Discussion: Patient was being treated for acute low back pain for approximately 2 weeks.  Patient denies trauma.  X-rays revealed an compression deformity but it was initially attributed to a 'slip and fall' one year prior.  Prior back pain had resolved.

MRI was ordered since there was very little response to treatement for current low back pain episode.  MRI revealed evidence of acute fracture deformity.  Upon further questioning of the patient, it was discovered that she had fallen out of her bedroom window try to sneak out of the house.  The doctor, not the parents, were made aware of this until AFTER the MRI results.


More about compression fractures:



http://www.emedicine.com/pmr/topic66.htm


http://www.ccjm.org/pdffiles/Mazanec203.pdf
References: Referring Physician:† Todd Hatch, DC
Comments:
No comments posted.
Additional Details:

Case Number: 8009974Last Updated: 02-27-2007
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: 02-02-2007Access Level: Readable by all users
Keywords: compression fracture, lumbar spine trauma, wedge fracture

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