Acute osteoporotic lumbar spine compression fracture
Acute on chronic back pain.
MRI Lumbar spine (selected images)
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Compression fracture of L5 vertebral body and oblique fracture also involving the L4 spinous process, both showing associated heterogeneous marrow signal that is hyperintense on T2 and shows vivid contrast enhancement. Interspinous ligament tear/distraction and right paravertebral soft tissue edema. The spinal canal is capacious, no retropulsion. The remainder of the imaged lumbar spine shows multilevel old compression/osteoporotic fractures.
This patient is known to have osteoporosis, the MRI findings are consistent with an acute L5 compression fracture, likely osteoporotic, and associated L4 spinous process fracture. The main differential at this age group would be secondary malignancy to bone causing a pathologic fracture, which is less favoured given the appearances and distribution of the enhancement, as well the other imaging and clinical findings supporting osteoporotic fracture.
- 1. Seo MR, Park SY, Park JS, Jin W, Ryu KN. Spinous process fractures in osteoporotic thoracolumbar vertebral fractures. The British journal of radiology. 84 (1007): 1046-9. doi:10.1259/bjr/32143781 - Pubmed
- 2. Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH. Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics : a review publication of the Radiological Society of North America, Inc. 23 (1): 179-87. doi:10.1148/rg.231025043 - Pubmed