Join our purpose-driven channel for practical pain management and experience a variety of benefits. Enjoy exclusive access to Master Class and Practical Class memberships designed to help you manage pain effectively.
/ @practicalpainmanageme...
Today, we'll dive deep into interpreting a lumbar spine X-ray, leveraging the ABCs rule we've emphasized: Alignment, Bone density, and Cartilage space.
If you need a quick refresher on the ABC criteria, don't hesitate to revisit our tutorial videos.
Now, let's have a glimpse at the patient's background. For a detailed history, make sure you delve into the provided case study:
We're looking at a 45-year-old male who experiences tingling sensations, which trace from his left gluteal region to the back of his thigh, coupled with pain in his right lower back.
Upon interpreting the alignment category of the lumbar AP view, each lumbar vertebral body, pedicle, spinous process, transverse process, sacral and iliac bone, and femoral head were meticulously evaluated. We focused on the outer shape, size, continuity of the bony cortex, alignment of each lumbar vertebra, asymmetry of the pelvic level, symmetric shape of the iliac bone, and femoral head. It was observed that the L5 vertebral body exhibits an indistinct shape, while other observations remain unremarkable.
The bone density was assessed by examining the diffuse or local bone density of the entire lumbar vertebral bodies, pedicle, sacrum, ilium, and femoral head, looking for any changes in bone density. Notably, there was diffuse osteosclerosis of the L5 vertebral body. However, the subchondral sclerosis appeared normal in other bones.
Upon assessing the cartilage space, attention was given to potential lumbar disc space narrowing, marginal spur formation of the lumbar spine, sacroiliac joint, and hip joint space. It was evident that the L5-S1 space was narrowing, but the rest appeared typical.
Regarding the soft tissue, shadows from the outer border of the psoas muscle layer, interfascial layer, and intestinal gas were evaluated. The gas shadow throughout the colon mimics the appearance of multiple radiolucent lesions in the iliac bone.
In the oblique view, narrowing was noted in the L5-S1 intervertebral space and sclerosis of the L5 body.
On the lateral view, particular attention was given to the entire outer border of the lumbar vertebrae, the alignment of the intervertebral segments, cartilage space narrowing, bone densities, and the dynamic movement of each segment.
Findings include subchondral sclerosis at L4-5 with a mild marginal spur without disc space and intervertebral foraminal narrowing.
There's severe cartilage space narrowing at L5-S1, diffuse subchondral sclerosis at L5-S1, and narrowing of foraminal stenosis at L5-S1. Instability is present at L4-5 and L5-S1, indicating that the L5-S1 degeneration process isn't yet stabilized.
----
On the pelvic x-ray, a well-defined dense calcification was observed in the right intertrochanteric region of the femoral bone, which appeared benign. Other findings were typical.
Potential causes of right lower back pain are discogenic pain originating from L4-5 or L5-S1, bone marrow pain from the L5 body, and facet joint pain at L4-5 and L5-S1.
For the left radiculopathy, possible causes include foraminal stenosis at L5-S1 and a herniated nucleus pulposus (HNP) at L4-5 or L5-S1.
Subsequent MRI evaluations revealed disc dehydration at L4-5 accompanied by a posterior annular tear and subchondral bone marrow edema.
The L5 body displayed mixed Modic changes, consisting of mixed fatty metamorphosis with bone marrow edema. There's severe degeneration of the L5-S1 disc accompanied by marginal spur formation, suggesting rapid disc destruction at L5-S1 coupled with inflammation in the L5-S1 disc and subchondral bone marrow.
Progression of an annular tear at L5-S1 was also evident.
Correlating these MRI findings with the presumed discography results: axial T2 weighted images for L4-5 and L5-S1 depict a diffuse circumferential annular tear.
Parasagittal oblique scans from medial to paracentral regions revealed foraminal stenosis due to an extruded hard disc characterized by a bulging annulus and reduced height of the intervertebral foramen.
#PracticalPainManagement #spinalintervention #imageguided #learning #imagetrain #GE #Ziehm #MSK #chronicpain #case #lecture #cervical #lumbar #knee #elbow #noninvasive #painfree #ISURA #paindiploma #montpellier #madi #precise #decisionmaking #limethasone #dexamethasone #palmitate
#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
26 авг 2024
