Oppenheimer ossicle

Case contributed by Dr Eid Kakish

Presentation

Low back pain after lifting a heavy object. Referred for a lumbar spine MRI.

Patient Data

Age: 30 years
Gender: Male

A well-corticated triangular bony fragment is seen at the left inferior articular process of L3, in keeping with an Oppenheimer ossicle. It demonstartes a hyperintese signal on T1 and T2, which is suppressed on STIR, reflecting fat metaplasia. 

Intervertebral disc disease in the form of a central annular fissure at L4-L5 and a broad-based central protrusion at L5-S1. No canal stenosis or nerve root compromise.

 

Annotated sagittal and coronal T2 weighted images:

Oppenheimer ossicle (red arrow)

Case Discussion

Usually an incidental finding, an Oppenheimer ossicle is an accessory structure resulting from a horizontal cleft through the inferior or less commonly the superior articular processes in the lumbar spine.

It can be mistaken for a pars interarticularis fracture or, rarely, for a calcified ligamentum flavum in older patients.

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