Clinical question: T12 compression fracture with neurologic changes. Signs and symptoms: Neurologic changes. Nonenhanced thoracic MRI:Examination demonstrates more than 50% compression fracture of T12 vertebrae with extensive T2/T2 hyperintensity of bone marrow consistent with edema and representing acute fracture. There is posterior expansion of compressed vertebrae into the spinal canal with resultant mass effect, flattening and posterior displacement of the cord and resultant moderate central spinal stenosis without neural foraminal compromise. There is also evidence of circumferential epidural hemorrhage (more along the dorsal aspect of the spinal canal) which extends superiorly to at least T3 level. Epidural hemorrhage is larger at T11 and T12 levels and measuring approximately 5.5 mm in thickness posterior. Epidural hemorrhage at L1 level with mass effect on the conus and the proximal cauda equina measures approximately 6.2 mm thickness. There is increased T2 signal intensity of the cord highly suspicious for edema without convincing evidence of hemorrhage and extending from T10-T11 disc level to the conus.Unremarkable nonenhanced MRI of thoracic spine and without evidence of spinal stenosis or significant neural foraminal compromise at any level.Nonenhanced lumbar MRI:Examination demonstrates dorsal epidural hemorrhage from acute T12 lumbar fracture with mass effect and forward displacement of conus and proximal cauda equina. There is increased T2 signal intensity extending from L1-L2 disc level inferiorly to S2 level with mass effect and forward displacement of cauda equina which is also suspected for hemorrhage within the spinal canal/subarachnoid space. This finding measures approximately at 9.5 mm at L3 level and 8mm at L5 level. This finding appears as a low signal intensity on T1-weighted images. There is no evidence of fracture or malalignment of the lumbosacral spine.T2 hypointense kidneys are noted. To exclude possibility of underlying pathology recommend follow-up with ultrasound studies.
1.Acute larger than 50% compression fracture of T12 vertebral body, retropulsion into the spinal canal, mass effect and posterior displacement of the cord with resultant moderate central spinal stenosis without neural foraminal compromise. There is evidence of cord edema extending from T10-T11 disc level to the conus.2.Circumferential epidural hemorrhage extending from the fracture site superiorly to at least T3 and inferiorly to approximately L1-L2 disc level with associated mass effect as detailed/measured above.3.Hemorrhage within the spinal canal extending from approximately the L1 level to S2 and with resultant mass effect and forward displacement of cauda equina along its entire course. 