Acute osteoporotic lumbar spine compression fracture

Case contributed by Dr Bruno Di Muzio

Presentation

Acute on chronic back pain.

Patient Data

Age: 90 years
Gender: Female
MRI

MRI Lumbar spine (selected images)

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, with no retropulsion. The remainder of the imaged lumbar spine shows multilevel old compression/osteoporotic fractures. 

Case Discussion

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 the bone causing a pathologic fracture, which is less favored given the appearances and distribution of the enhancement, as well the other imaging and clinical findings supporting osteoporotic fracture. 

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