Clinical question: Rule out compression fracture. Signs and symptoms: Pain and tenderness in lower back. Nonenhanced lumbar MRI:There are patchy foci of T1 and T2 hyperintense and T2 STIR isointense throughout the lumbar spine consistent with inhomogeneous marrow signal changes. This finding is nonspecific and often is detected in patients of upper age group.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet and ligamentum flavum hypertrophy and including mild bilateral facet effusion. No spinal stenosis however moderate left and mild to moderate right neural foraminal compromise is detected.There is less than 50% compression deformity of the superior endplate of L4 without retropulsion into the spinal canal. There is very subtle linear T2 STIR hyperintensity of the depressed endplate and normal signal intensity of the marrow space otherwise. This fracture is likely chronic in etiology.L4-L5 demonstrate mild disc disease and loss of disc height, significant left and mild right facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No central spinal stenosis however mild bilateral (left greater than right) neural foraminal compromise is detected.L5-S1 demonstrate advanced disc disease and loss of disc height, asymmetric moderate left facet hypertrophic changes and mild right facet and bilateral ligamentum flavum hypertrophy. There is significant left neural foraminal compromise however without central spinal stenosis and patent right neural foramina.
1.Less than 50% compression fracture of superior endplate of L4 vertebrae without malalignment and likely representing chronic fracture.2.Degenerative changes of lumbar spine however without evidence of central spinal stenosis at any level.3.Significant left neural foraminal compromise at L5-S1 and mild neural foraminal compromise levels.