Malignant vertebral structural collapse
A known case of breast cancer presenting with low back pain and limb numbness.
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An abnormal pathological process of marrow infiltration and replacement is seen involving the examined lower dorsal and lumbar vertebrae and the posterior neural arches of some of them, appearing as low signal on T1 and high signal on T2 weighted images, with non-homogeneous enhancement. Partial structural collapse of the L1 vertebra is noted with posterior vertebral surface convexity bulging into the spinal canal.
Most vertebral compression fractures are of benign origin. Less common causes include metastatic, hematologic or neoplastic disease. The spine represents the most frequent site of skeletal metastasis predominating in the thoracic and lumbar spine.
It is essential to differentiate benign from malignant vertebral collapse because their medical management and their outcome are substantially different.
Features supporting malignant collapse include involvement of dorsal elements, bulging of the dorsal vertebral wall, involvement of the posterior half of the vertebral body, associated soft tissue mass, contrast enhancement and multi-segmental involvement of vertebrae.
The case was confirmed as metastatic disease on bone scan.