Presentation
Low back pain. No relevant medical histoy.
Patient Data
Fluid-filled cavity in the anterior and mid-region of D11, with clearly defined and sclerotic borders and narrow zone of transition. There is some fat preservation on the posteroinferior vertebral region. There is also anterior vertebral body partial collapse. Posterior vertebral wall is protruded into the spinal canal with no cord compression or underlying myelopathy. D10-D11 level shows right more than left moderate neuroforamen stenosis with signs of mild radicular compression. Spinous process of D10 shows vertical tract with associated bone and soft tissue oedema, in keeping with a fracture. Oedematous aspect of D10 spinous process as well, suggesting some degree of instability. Interspinous ligaments are preserved.
Superior and inferior endplates of L1 also shows ill-defined low signal on T1 and high signal on STIR, in keeping with micro trabecular osteoporotic fractures. There is also partial height reduction in the lumbar vertebral bodies as well as intervertebral disc signal loss.
Bulging L4-L5 disc.
Incidental muscular volume loss, in keeping with sarcopenia.
Case Discussion
Fluid-filled cavities may be found in vertebral body osteonecrosis, also known as Kummell disease. No air was seen in the vertebra in this particular case 1. Adjacent vertebral bodies' osteoporotic fractures favour this diagnosis.
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