low back pain with radiculitis (Full Version)

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Alex Brenner PT MPT OCS -> low back pain with radiculitis (August 22, 2005 1:56:00 AM)

 
38 year old female complains of low back pain, left hip pain, and radiating pain down the posterior thigh and into left calf. Reflexes are symetrical, no peripheral weakness, sensation is intact in bilateral dermatomes. Plain film radiographs were obtained. What are the findings?
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Sebastian Asselbergs -> Re: low back pain with radiculitis (August 22, 2005 2:05:00 AM)

First of all, she needs to do #2....



SJBird55 -> Re: low back pain with radiculitis (August 22, 2005 2:08:00 AM)

Hmm... bet she's not a vegetarian.



Sebastian Asselbergs -> Re: low back pain with radiculitis (August 22, 2005 2:10:00 AM)

Strange looking sacrum and left SI and scoliosis and....left SI joint area is really strange - almost looks like a fracture...



nari -> Re: low back pain with radiculitis (August 22, 2005 2:36:00 AM)

Partial sacralisation?? L5 or loss of joint space posteriorly; very odd (L) SIJ; scoliosis which may or may not be relevant; sacrum looks odd in AP and lateral views (very straight).....not a very nice spine for someone so young.

Nari



Jeep -> Re: low back pain with radiculitis (August 22, 2005 3:01:00 AM)

multiple congenital anomalies involving L5 and sacrum. Unilateral pars defect, dysplasia of the left sacral plateau. The inferior right SI joint is also noted. I do not visualize an articulation at L5/S1 right. Constipation is a common condition in LBP patients. I would expect her ROM to be assymetrical. This is a permanent condition, and I would expect her to have intermittent LBP throughout her life, and at risk for accelerated DJD development in this area.



ehanso -> Re: low back pain with radiculitis (August 22, 2005 4:01:00 AM)

The L side of the sacrum looks more translucent almost osteopenic. Almost like a collapse of the structure. Is there something Lytic going on here?



JLS_PT_OCS -> Re: low back pain with radiculitis (August 22, 2005 6:32:00 AM)

I see DDD L5/S1, the pars defect, and the dysplasia of the sacrum, not sure what that represents.
I see perhaps a GRI spondylolisthesis as well?

The scoliosis makes me think there may be a lytic process going at the left sacrum.

Good case.
J



UTDC -> Re: low back pain with radiculitis (August 22, 2005 7:36:00 AM)

Congenital stuff- anamolous lumbosacral articulation with possible pseudoarticultaion off the left transverse. Difficult to visualize due to bowel gas. Recumbent film, so curve could just be positional. I don't see the listhesis. I can't say there is evidence of a lytic lesion, although I question a blastic appearence inferior to the left L5 pedicle; a difficult read- one for the radiologists.



jma -> Re: low back pain with radiculitis (August 22, 2005 7:55:00 AM)

Scoliosis. Whats going on with the left SI joint?



FLAOrthoPT -> Re: low back pain with radiculitis (August 22, 2005 6:30:00 PM)

are we allowed to order more films from a better machine? or a fleet enema?



JLS_PT_OCS -> Re: low back pain with radiculitis (August 23, 2005 6:33:00 AM)

Can I recommend a Vegan diet for the bowel gas?
:)

J



Jeep -> Re: low back pain with radiculitis (August 23, 2005 7:20:00 AM)

My impression- The scoliosis is a structural one, resultant to the wildly anomolous L5/Sacrum. I agree with UTDC on the pseudoarticulation(L5/S1 left). The "lytic appearance" of the left sacrum is due to bowel gas/fecal material.



Sebastian Asselbergs -> Re: low back pain with radiculitis (August 23, 2005 8:06:00 AM)

Jeep, would you bet on that? I think you're right, but without another look - can we be sure?



Sebastian Asselbergs -> Re: low back pain with radiculitis (August 23, 2005 8:07:00 AM)

with regards to the "lytic" look I mean. Sorry.



UTDC -> Re: low back pain with radiculitis (August 23, 2005 8:26:00 AM)

Sebastian,
With the limited sensitivity/specificity of plain film one can never be sure. I think that the key here is that the appearance is consistent with a bowel gas pattern. If one were concerned or the patient presentation was such that the practitioner felt that it was necessary, other imaging modalities could be employed- namely CT/MRI.

Digging back in my memory, I believe that there needs to be approximately 60% destruction of bone before a lytic appearance can be appreciated on x-ray.

Jeff



Jeep -> Re: low back pain with radiculitis (August 23, 2005 8:32:00 AM)

Sebastian-
No- I cannot be 100% "sure" especially on a computer screen. But I have seen hundreds of similar appearing films in which that was the case, and especially of LBPs(constipation is a common concurrent condition). As I said- it is my "impression", (based on what I see on the computer, education, clinical experience).

Would I bet on it? In consideration of the above,.........Yeah!!(I feel the odds are on my side!). Especially with the bowel gas visualized at the same area on the lateral views. If that was not present, then my impression would be different.



Synergy -> Re: low back pain with radiculitis (August 23, 2005 9:04:00 AM)

Solution: Have this patient rip a butt-shattering fart and re-shoot the films. It may clear the way for a more improved view. Agreed? :)

P.S. I realize the immaturity of the statement, but I couldn't 'pass' it up.



Jeep -> Re: low back pain with radiculitis (August 23, 2005 10:22:00 AM)

Good one Chris!!!

That brings up another very important point-
Getting good films the first time, so patients are not radiated uneccessarily due to poor film quality. A good history should have revealed the constipation problem. A pre-film enema may have been a prudent consideration.

Is all this built up gas in soldiers a new secret weapon?(send in a few thousand flatulent troops to "gas" out the enemy?)



nari -> Re: low back pain with radiculitis (August 23, 2005 1:12:00 PM)

I did wonder earlier about the 'lytic' appearance being an artifact...but the lower aspect of (L)SIJ still looks peculiar.
Good point, Jeep, about recognising before irradiating, the likelihood of a full bowel's impact on viewing.

Nari



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