Imaging diagnosis
Case 322
【Discussion】
Spine is one of most important structures for vertebral mammals, especially for human with walking by two feet. Spine for human functions to support our weight. Spine composes of vertebra, disk, and spinal canal. Although spinal canal least functions to hold our weight, vertebra body and disk hold our weight anteriorly and intervertebral joints hold it posteriorly.
Vertebral arch composes of vertebral body, spinous process, transverse process, lamina, and pedicle. Lamina is like a bridge between spinous process and traverse process, while pedicle, a bridge between vertebral body and traverse process.
Intervertebral joint is formed by superior articular process and inferior articular process and works to support our weight posteriorly especially when moving and lifting heavy stones up from ground. Further it works to support our spine when rotating force is forced such as golf swinging, and bat swinging.
Pedicle is a bridge between vertebral body and transverse process. Pedicle is susceptible to be injured by body rotation burden.
Lumbar pain occurs in adult and child. Lumbar pain in adult occurs with aging and arises from various reasons. It occurs not only from space occupying lesions such as bone tumor irrespective primary or metastatic and abscess irrespective of vertebra or disk, but also from degenerative lesions such as degenerative osteoarthritis, spinal canal stenosis, compression fracture, spondylolisthesis disk hernia including Schmorl nodule which are commonly experienced. Further, injures of intervertebral joint between superior articular process and inferior articular joint, causes lumbar pain when lifting heavy burdens or suddenly inclining forward (1-4). Lumbar pain occurs in child or adolescent arises from spondylolysis, spondylolisthesis and disk hernia. Spondylolysis arises from fracture and separation of pedicle when repeated move of body rotation such as bat swinging, judo sporting (5-7).
In our Case 1, he played a little league baseball player who often swinged a bat appealed lumbago. Lumbar MRI depicted low signal intensity on T1WI and high signal intensity on T2WI, indicating bone marrow edema of vertebral arch, immediately before spondylolysis. He got protect brace to inhibit body rotating. In our Case 2, she had lumbar and left hemiplegia. Lumbar MRI depicted chronic intervertebral arthritis and localized Schmorl nodule, probably causing lumbar edema. Interestingly, T1WI and fat suppression T2WI depicted a lesion with marked low signal intensity and high signal intensity, respectively, corresponded to continuous subcutaneous fat tissue along with lumbar spine. It might be probably due to lying bed for long time because she was unable to rise up by herself.
【Summary】
We presented two cases with lumbago; Case 1, a thirteen-year-old boy with bone edema of pedicle, threatened to move to spondylolysis: Case 2, a seventy-four-year-old female with chronic intervertebral arthritis and relatively fresh Schmorl nodule. It is borne in mind that vertebral arch composes of spinous process, transverse process, vertebra itself, lamina and pedicle. In lumbago of child, spondylolysis with stress burden of pedicle should not be overlooked, while in that of adult, intervertebral arthritis should not be overlooked induced by lifting heavy luggage up from ground or rotating movement such as golf swinging or bat swinging. Further, edematous change of subcutaneous tissue at lumbar spine come from lying bed for long time.
【References】
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2024.1.11