MyPACS.net: Radiology Teaching Files > Case 14506891

never visited THREE-LEVEL COMPRESSION FRACTURE OF THE LUMBAR SPINE
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 32 year old male
History:

Low back pain. Rule out compression fracture. Status post epileptic seizure.

Images:[small]larger

Fig. 1: AP L-SPINE

Fig. 2: LATERAL L-SPINE

Fig. 3: SAGITTAL T2

Fig. 4: SAGITTAL T2 FATSAT

Fig. 5: SAGITTAL T1

Fig. 6: THORACOLUMBAR SPOT
Findings:

MRI examination of the lumbar spine reveals and confirms the presence of three compression fracture deformities of T12, L1, and L2. These compression fractures affect the superior endplates and create 10% to 20% loss of anterior vertebral body height given their wedge-shaped appearance. This is most pronounced at L1. A fourth, more subtle, endplate compression deformity is noted at the superior endplate of T11. This is clearly seen on sagittal image #6. There is no retropulsion of the vertebral contents into the spinal canal. There are no associated herniated discs although the associated endplate fractures do show early acute Schmorl’s node defects (intravertebral herniations).


The L3, L4, and L5 vertebral bodies are unremarkable other than degenerative changes of the endplates noted at L4-5 and L5-S1. The L4-5 and L5-S1 intervertebral discs also show dorsal bulging and annular fissuring measuring 2-3 mm, encroaching upon the thecal sac. There is asymmetry of the L5-S1 disc bulge lateralizing more to the right side, narrowing the right neural foramen and effacing the traversing and exiting nerve root sleeves. The spinal canal and contents are well maintained, but there is mild narrowing of the spinal canal at L4-5 and L5-S1. The conus medullaris does not show any intrinsic lesion. The posterior elements of the lumbar spine are well maintained other than some mild hypertrophic asymmetrical changes of L5-S1. The paraspinal lumbar musculature is symmetric without any atrophy or intrinsic abnormality. Retroperitoneal structures visualized are normal.

XRAY:
X-rays of the thoracic spine show multiple compression fracture deformities at T12, L1 and L2. This is most pronounced at L2 where there is approximately 20% loss of vertebral body height. The other two vertebral bodies show approximately 10% loss of vertebral body height. The fractures do have an acute presentation with endplate disruption especially at the L2 vertebral segment. There is accentuation of the thoracolumbar kyphosis most likely attributed to these acute fractures. Soft tissues do not show any abnormal masses or calcifications. Disc spacing is adequate. There is a shallow lumbar lordosis. There is no scoliosis.

Diagnosis:

MRI  CONCLUSIONS:

1. ACUTE COMPRESSION FRACTURES OF T12, L1, AND L2 AS DESCRIBED AND CORRELATING TO THE X-RAY EXAM PERFORMED THE SAME DATE. FOURTH COMPRESSION ENDPLATE FRACTURE DEFORMITY OF T11 ALSO REVEALED. VERTEBRAL BODY HEIGHTS ARE DIMINISHED BETWEEN 10% AND 20%, WITH THE MOST PRONOUNCED LOSS OF VERTEBRAL BODY HEIGHT AT L1.

2. NO EXTRADURAL DEFECTS CREATED BY THE COMPRESSION FRACTURES IDENTIFIED.

3. DEGENERATIVE INTERVERTEBRAL OSTEOCHONDROSIS WITH SCHMORL’S NODE DEFECTS AND DORSAL ANNULAR BULGING, L4-5 AND L5-S1, ENCROACHING UPON THE THECAL SAC BY 2-3 MM.

4. RIGHT NEURAL FORAMINAL NARROWING DUE TO ASYMMETRY OF THE DEGENERATIVE CHANGES AND POSTERIOR FACET JOINT HYPERTROPHY. CLINICAL CORRELATION ADVISED FOR INTERMITTENT RIGHT L5 AND/OR S1 RADICULAR INVOLVEMENT.



XRAY CONCLUSIONS:

1. THREE ACUTE COMPRESSION FRACTURE DEFORMITIES T12, L1 AND L2 WITH BETWEEN 10 AND 20% LOSS OF ANTERIOR VERTEBRAL BODY HEIGHT AS DESCRIBED.

2. LOSS OF LUMBAR LORDOSIS WITH KYPHOTIC ACCENTUATION OF THORACOLUMBAR JUNCTION.

References:

REFERRING PHYSICIAN: GINA ZUMMO, DC

Comments:
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Additional Details:

Case Number: 14506891Last Updated: 04-08-2008
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: 04-04-2008Access Level: Readable by all users

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