Pathologic T12 fracture. Back and buttock pain. There is a sigmoid-shaped thoracolumbar curvature that is convex to the right in the lumbar region. There is straightening of the lumbar segment as well. There is minimal anterior subluxation of L2 to relative to L3. This is associated with multilevel L1 through L3 central/anterior vertebral body compression fractures. - The L2 vertebral body compression fracture is predominantly central and anterior and is associated with complete replacement of the marrow even extending into the pedicles. The L2 compression results in about 30% height loss. The fracture is associated with a mild predominantly right sided posterior retropulsion/epidural component but no significant thecal sac compression.- There are even more severe compression fractures at L1 and L3 (about 60% height loss) fatty in signal which may reflect osteoporosis or previous radiation treatment. Focal edema-like signal adjacent to the inferior endplate of L3 is probably from an acute/subacute intravertebral herniation of disc.The conus medullaris tip is at T12-L1 level. The conus medullaris has normal morphology and signal characteristics.T11-T12: There is no neural foraminal or spinal canal stenosis.T12-L1: Small and disc bulge but no spinal canal or neural foraminal narrowing.L1-L2: There is mild disc bulge causing no significant spinal canal or foraminal narrowing. However, the L2 compression fracture and associated retropulsion is associated with mild right paracentral spinal canal narrowing as described above.L2-L3: On a background of short pedicles (congenital spinal canal narrowing), there is degenerative disc disease and uncovering along with severe ligamenta flava buckling. These result in moderate spinal canal narrowing. There is no significant neural foraminal narrowing.L3-L4: There is disc bulge and ligamenta flava buckling resulting in mild spinal canal narrowing. There is also facet arthropathy resulting in moderate-to-severe left and mild-to-moderate right neural foraminal narrowing.L4-L5: There is almost complete loss of disc height at this level associated left subarticular recess mild narrowing. There is also ligamenta flava buckling resulting in mild spinal canal narrowing. There is bilateral moderate neural foraminal narrowing given the disc height loss.L5-S1: There is a minimal disc bulge resulting in mild right-sided subarticular recess narrowing. There is also moderate right and mild left neural foraminal narrowing.
1.L2 compression fracture (30% height loss) is probably pathologic given the loss of the normal marrow signal. However, an acute insufficiency fracture with severe edema can also look similar. It is associated with mild posterior retropulsion/epidural component resulting in mild spinal canal narrowing. 2.L1 and L3 compression fractures (60% height loss) are probably insufficiency fractures and are associated with no significant spinal canal narrowing.3.Multilevel degenerative lumbar spondylosis is most pronounced at L2-L3 where there is moderate spinal canal narrowing.