CASE 16

By: Dr. Sattam Lingawi and Dr. Alaa Al-Turkustani

HISTORY: 62-year-old male patient presented with back pain.

What are your findings?

What is the differential diagnosis?

FINDINGS:

Fig. 1: Lateral plain radiograph of the lumbar spine demonstrating L1 compression fracture and L3-L4 severe degenerative disc changes.

Fig. 2: Sagittal reconstructed image of lumbar spine CT scan demonstrating L1 vertebral body burst fracture with compression fracture of the inferior endplate of L3 vertebral body & L3/4 grade 1 retrolisthesis. No underling lesions noted.

Fig. 3, 4 & 5: T1 (Fig. 3), T2 (Fig. 4) and post contrast T1 with fat saturation (Fig. 5) MRI of the lumbar spine demonstrating L1 non-pathological fracture with low signal intensity band on T1 and T2, representing compressed bone trabeculae.  Minimal retropulsion of the vertebral body is noted causing mild spinal canal narrowing. No paraspinal or intra-spinal soft tissue masses detected. At L3/L4, there is grade 1 retrolisthesis with intervertebral disc & end plate degenerative changes. The post contrast images did not demonstrate any abnormal enhancement.

DIFFERENTIAL DIAGNOSIS:

• Osteoporotic (non-pathological) vertebral body fracture.

• Pathologic compression fracture.

DIAGNOSIS:

Non-pathologic (osteoporotic) fracture.

PEARLS AND DISCUSSION:

MR imaging findings are useful for differentiation between metastatic from acute osteoporotic non-pathologic fracture from pathological fracture. A low-signal-intensity band on T1- and T2-weighted images in the background of normal bone marrow signal intensity of the vertebral body, retropulsion of a posterior bone fragment, and multiple compression fractures are suggestive of osteoporotic compression fractures.

A convex posterior border of the vertebral body, abnormal signal intensity of the pedicle or posterior element, an epidural or focal paraspinal mass are suggestive of pathologic compression fractures.

FURTHER READING:

1. Hee-Sun Jung, MD ● Won-HeeJee, MD, Discrimination of metastatic from Acute Osteoporotic Compression Spinal Fractures with MR Imaging.RadioGraphics 2003; 23:179–187.

2. LubdhaM. Shah andKaren L. Salzman, Imaging of Spinal Metastatic Disease, Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2011, Article ID 769753, 12 pages doi:10.1155/2011/769753