SCHEUERMANN’S DISEASE

Case History

This 14 year old male patient presents with persistent mid to lower thoracic pain aggravated by playing football.

Discussion

Notice the anterior wedging of the vertebral bodies of T7, T8 and T9. There are Schmorl’s node indentations present on the anterior inferior endplates of T7, T8 and T9. The anterior wedging of these vertebral segments are associated with irregularity of the anterior growth plates of these respective thoracic segments. There is a moderate increase in the thoracic kyphosis noted. These findings are consistent with the diagnostic of Scheuermann’s disease. Scheuermann’s disease is a spinal disorder of unknown cause affecting the adolescent athlete leading to pain and occasionally cosmetic deformity. Most patients are between the ages of 13 and 17 with a male predominance. It most commonly affects the mid to lower thoracic regions. Pain, fatigue and an increase in the anterior kyphosis is often seen. The radiological features should include at least three contiguous vertebrae with each creating an anterior wedged appearance of at least 5 degrees, irregular vertebral endplates often associated with Schmorl’s nodes and decreased disc height along with increased kyphosis. Conservative treatment and management is recommended and reduction in physical activity during the acute symptoms is recommended.

Reference

Yochum and Rowe, Essentials of Skeletal Radiology, Lippincott, Williams & Wilkins Publishers, 2005

Spondyloptosis - Grade V - Spondylolisthesis

Case History

A 59-year-old female patient is complaining of lower back pain that has lasted four days. There is no previous history of back pain, cancer, or surgery. All three of her children were delivered via C-Section. At present, the patient’s low back pain is constant.

Discussion

Observe the severe anterior displacement of L5 upon the sacral base representing “spondyloptosis”. The vertebral body of L5 is triangular in its position which is an adaptation to the patient’s longstanding presence of spondylolisthesis of a “Grade V” nature (multiple arrows outlining the L5 vertebral body). There is no disc space left between the L5/S1 level. There is a rounding off of the anterior surface of the sacrum which has been referred to as “doming”. There is a curvilinear appearance on the area of the sacral base on the frontal projection which has been referred to as the “Bow Line of Brailsford.” This curvilinear radiopacity represents the L5 vertebral body superimposed on the sacral base (multiple arrows outlining the vertebral body of L5).

Also notice, there is an old, healed compression fracture with depression of the superior vertebral endplate of L2.

Comment

Be assured, patients with Grade V spondyloptosis have had their spondylolisthesis since early childhood. It’s amazing that this patient has no neurological deficit nor symptoms of radiculopathy. Years ago, if a woman was pregnant with the appearance of spondyloptosis, a Cesarean Section would have been an immediate conclusion. I have seen more than one case, with this degree of spondyloptosis, where a child has been born naturally through the pelvic canal. Of course, that patient should not deliver with a midwife or have a home birth; that patient should be in the hospital in case emergency care is necessary. In conclusion, I believe this patient’s back pain is unrelated to the advanced spondyloptosis of L5.

Courtesy of the Livesay Chiropractic Clinic, Johnson City, TN

Reference

Yochum & Rowe, Essentials of Skeletal Radiology, 3rd Edition, Lippincott, Williams and Wilkins, Chapter 5, 2005

VAS DEFERENS CALCIFICATION - ASSOCIATED DIABETES MELLITUS

Case History

This is 47 year old male patient complaining of lower back pain without radiculopathy.

Diagnosis

Observe the calcification within the vas deferens which diverges from the midline above the pubis in a tubular pattern. On occasion the vas deferens can be traced along its course through the inguinal canal to the scrotum. This calcification is benign in nature and actually pathognomonic for diabetes. It is somewhat unusual for a patient of this young age to have vas deferens calcification. No further imaging of this is necessary and this is not thought to be symptom generating.

Reference

Yochum & Rowe, Ch. 18, Masqueraders of Musculoskeletal Disease, 3rd ed., 2005