Case 34 - Compression Fracture & Stress Injury

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Severe headache, accidental fall, normal range of motion, difficulty with balance after motor vehicle accident with intracranial hemorrhage in the past status post fall on the sacrum. Severe pain and difficulty sitting.

TECHNIQUE: Axial CT scan images were performed through the brain, thoracic, and lumbar spine with multiplanar reconstructions of the axial CT data.

FINDINGS:

Brain:

There is no evidence of intracranial hemorrhage. No mass effect is seen. The ventricles are enlarged out of proportion to the degree of sulcal enlargement. The calvarium shows no fractures. There are a few low density areas in the frontal calvarium seen best on series 5 image 220 and series 5 image 140 and series 5 image 100, nonspecific in the etiology.

There appears to be evidence of previous orbital floor fracture on the right side with healing. There is right sphenoid sinus fluid.

Thoracolumbar spine:

There is overall osteopenia. There is compression deformity of the superior endplate of L4 with an element of sclerosis suggesting chronicity. In the T10 vertebra there are vertical striations indicative of hemangioma. There is no evidence of thecal sac or spinal cord compromise. There is grade 1 anterolisthesis of L4 with respect L5.

Axial scans through the thoracolumbar spine show degenerative facet joint disease, right greater than left at the T2-3 level. Milder changes are present at T6-7.

The axial scans through the T10 level show the hemangioma of the bone to the left of midline. No canal compromise is seen.

Mild disc bulge is present at L1 to minimally indenting the thecal sac. Similar findings are present at L2-3 and L3-4. Degenerative facet joint disease, right greater than left is present at L4-5 with a central to right paracentral disc herniation compressing the thecal sac and likely the right L5 nerve root. The AP diameter spinal canal at the L4-5 level is narrowed to 8 mm. There is ligamentum flavum thickening also on the right side contributing to lateral recess stenosis at the L4-5 level as well as right greater than left foraminal narrowing.

The L5-S1 level also shows moderate degenerative facet joint disease and minimal disc bulge without nerve root compromise.

Sacroiliac joint vacuum phenomenon is present bilaterally.

There is aortic calcification.

A prior study from August 7, 2016 shows the anterolisthesis of L4 and L5 but the compression deformity is new.

The ventricular enlargement was present on the prior examination from March 2, 2012 but has increased in the interval.

IMPRESSION:

Ventricular enlargement out of proportion to the degree of sulcal enlargement slightly worse compared with previous evaluation from March 2, 2012. Consider clinical evaluation for adult normal pressure hydrocephalus.

New compression of the superior endplate of L4. The presence of sclerosis suggest that this is not acute but it has occurred since August 7, 2016. To assess for age better, STIR MRI may be helpful.

Left-sided T10 hemangioma of bone.

Mild degenerative changes in the thoracolumbar spine.

Small lytic lesions of the calvarium which were also present in March 2012, likely benign.
_____________________________________________________________________________________

Indication: Compression fracture of L4 vertebra. Intractable pain.

Technique: Sagittal T1 weighted, sagittal T2 weighted, sagittal STIR, axial T1 weighted, and axial T2 weighted scans were performed through the lumbar spine.

Findings:

The conus medullaris has normal signal intensity and terminates at an appropriate level.

The alignment of the vertebral bodies and the signal intensity of the vertebral bodies show abnormal signal intensity in the superior endplate of the L4 vertebra. This shows high signal intensity on the STIR images extending to the pedicles. In addition there is abnormal signal intensity in the L1 vertebra with increased signal intensity on the STIR images.

There is slight anterolisthesis of L4 the respect L5 and L5 with respect to S1.

Axial scans through the lumbar spine shows a tiny right paramedian disc herniation at L1-2 without thecal sac compression. The L2-3 level is unremarkable. The L3-4 level shows mild degenerative facet joint disease and ligamentum flavum thickening. The

L4-5 level shows right-sided disc bulge extending into the right neural foramen with foraminal stenosis and ligamentum flavum thickening with degenerative facet joint disease. The central canal is mildly narrowed to approximately 9 mm. The L5-S1 level shows degenerative facet joint disease.

Parasagittal images show mild foraminal stenosis at L3-4 and L4-5 on the right side and L4-5 on the left side.

IMPRESSION:

Increased STIR signal intensity in the L1 vertebra and the superior endplate of L4 compatible with recent fractures.

Mild degenerative changes at the L4-5 level.

The pattern of signal intensity abnormality is not suggestive of metastatic disease.