Acute osteoporotic lumbar spine compression fracture

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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