Presentation
Chronic lower back pain.
Patient Data
Alignment: mild L5 on S1 anterolisthesis
Vertebral bodies: Five non-rib bearing vertebral bodies are present. The vertebral body heights are preserved without compression fractures. Normal bone mineral density. Multilevel anterolateral bridging osteophytes and endplate sclerosis.
Disc spaces: mild multilevel disc space narrowing, worse at L4-L5 and L5-S1.
Facet joints: no jumped or perched facets. Multilevel facet arthropathy is worse at L4-L5 and L5-S1.
Posterior elements: grossly intact
Soft tissues: unremarkable. Atherosclerotic calcifications of the abdominal aorta and vascular calcifications in the pelvis. Cholecystectomy clips are projected over the right upper quadrant.
Sacroiliac joints are symmetric with mild degenerative changes.
Impression:
there is no evidence of acute fractures or subluxations in the lumbar spine
multilevel spondylosis is worse at L4-L5 and L5-S1 levels, as described above
Case Discussion
This represents a case of multilevel spondylosis. The patient is a 60-year-old male who presented to the emergency department due to suicidal intent. He also complained of lower back pain for two years. An x-ray confirmed multilevel facet arthropathy.