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CASE STUDY FOR M-1 STUDENTS
CASE #1
Patient presents to his doctor
with complaint of back pain with
increasing intensity.
L-2
Diagnosis:
L-5
1-Degenerative Disc disease
at (L2-3 and L4-5)
1
1
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
Your interpretation here.
RADIOLOGY EXAM: Lateral Lumbar Spine
Normal L2 vertebrae
CLINICAL INDICATION: Back pain increasing
in intensity.
REPORT: The patient has degeneration of
IV discs at the L2- L3 level and the L4-L5
level .
L-2
Disc degeneration
at L2-L3 with bone
spurs.
L4-5 foramen
CONCLUSION: Patient shows signs of
degenerative disc disease affecting L2-3 and
L4-5.
Normal L4
vertebrae
Disc
degeneration
at L4-L5
L-5
1
1
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
Source of pain is due to inflammation and
abnormal micromotion instability.
Many cases can be managed by antiinflammatory medication, physical therapy
and bed rest.
Most common cause of disc degeneration is
aging.
11
SPINE CASE #2
11 year old male in the trauma room
following a head on collision.
Diagnosis:
Atlanto-occipital
dislocation
2
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
RADIOLOGY EXAM: Cross table lateral
cervical spine x-ray.
Cross table
lateral
CLINICAL HISTORY: 11 yom in trauma room
following a head on collision
Abnormal curvature
of C-Spine
Widened C-1
occipital space
Normal C-5
vert. body
Normal IV foramen
Normal spinous process
REPORT: The space between the skull and
C1 is widened greater than normal. The
occipital condyles are not resting on the
superior articular surfaces of C-1.
CONCLUSION: The high impact of the
collision caused disruption of the Atlantooccipital joint.
2
Three bullet points about pathology
identified.
OR
Management of the identified process
50 words or less
The membranes and ligaments holding
the skull onto C1 are damaged during this
type of injury causing the skull to dislocate
from the rest of the spine.
An Atlanto-occipital dislocation may occur
without a fracture of the fracture of the C1
vertebra.
Atlanto-occipital dislocations can often be
fatal, even without a fracture of the c1
vertebra.
2
CASE # 3
Patient goes to the doctor with
the complaint of pain and
reduced range of motion of his
back.
Diagnosis:
Ankylosing spondylitis
“Bamboo Spine”
3
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: AP and Lateral Lumbar
Spine
CLINICAL INDICATION: Decresed range of
motion. Chronic lower back pain.
Normal IV disc
REPORT: Fused vertebral bodies at multiple
disc levels. Scoliosis in the lower thoracic
region. Fused sacroiliac joints.
Scoliosis
Normal IV foramen
Fused
vertebral
bodies
Sacrum
CONCLUSION: The fused vertebral bodies
and fused sacroiliac joints indicated that
the diagnosis is Ankylosing spondylitis.
3
Three bullet points about the pathology
OR
Management of the identified process
50 words or less
Ankylosing spondylitis is a form of
arthritis, primarily affection the spine
Most people with AS have a gene that
produces the genetic marker for the
protein HLA-B27
Can also cause swelling in other areas,
such as shoulders, hips, ribs, heels and
small joints of the hands and feet
3
20 YEAR OLD MALE WITH BACK PAIN
Diagnosis: Spondylolysis of L-5
4
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confirm the diagnosis and /or other abnormalities.
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Rib
RADIOLOGY EXAM: Lateral Lumbar spine x-ray
Normal L2
vertebral body
Intervertebral
foramen
Pars defect.
CLINICAL INDICATION: Lower back pain
REPORT: X-ray shows defect indicating a
fracture at the L5 inferior articular process at
the pars interarticularis. The other
zygopophysial joints appear normal.
CONCLUSION: Spondylolysis of the L5
vertebra
4
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
May be caused by failure of the Centrum of
L5 to unite adequately with the neural arches
at the neurocentral joint during development.
Bracing , Rest and physical therapy are used
for the management of pain
4
Patient has back pain and
positive lab work up for proteinuria.
Diagnosis: Multiple myeloma
5
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: Lateral lumbar spine
Flattened
vertebra
CLINICAL INDICATION: Back pain and
positive labs for proteinuria.
Osteoporotic
bone
Foramen
Normal
bowel gas
Endplate bowing
Spinous
process
REPORT: Osteoporotic vertebral bodies in
the lumbar spine with bowed endplates.
CONCLUSION: Due to positive lab workup
for proteinuria and areas of osteoporosis
in the spine and vertebra, multiple
myeloma has to be considered.
5
Three bullet points about pathology identified
OR
Management of the identified process
 Multiple Myeloma begins when plasma
cells become abnormal and continue to
divide.
 Over time cells collect in bone marrow
crowding normal blood cells and causing
extensive destruction to bone leading to
osteoporosis.
 Abnormal plasma cells secrete abnormal;
proteins which can lead to clotting and kidney
failure.
5
80 year old woman goes to
the doctor with pain in her
neck.
She is currently being treated
For Rheumatoid arthritis
Diagnosis;
C 1-2 Subluxation
6
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: Lateral C-spine X-ray
Increased
distance
between the
anterior arch
of C1 and the
dens
Note the position of
the posterior tubercle
of C-1
Normal C-6
spinous process
CLINICAL INDICATION: 80 YOF rheumatoid arthritis
patient with neck pain.
REPORT: The distance between the posterior
surface of the anterior tubercle of C-1 and the
anterior surface of the dens is markedly increased
indicating that there is disruption of the transverse
ligament of C1 and C2. There is also degenerative
disc narrowing at C3 through C6.
Normal C7
vertebral body
Normal C7-T1
disc space
CONCLUSION:C1-C2 Subluxation
Degenerative disc narrowing at C3-C6
6
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
 C1-C2 subluxation can cause pain in flexion
because C1 will compress the spinal cord.
 Rheumatoid arthritis can cause stretching
and destruction of the transverse ligament
which allows C1 to move forward relative to
C2.
 C1-C2 subluxation tends to occur because
of pannus formation at the gliding synovial
joints.
6
Case #7
A 75 year old woman goes to the ED
complaining of neck pain. She tells
doctor that she fell down her steps(4)
yesterday.
Study the image—add your diagnosis
in the place provided and send back to
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis: Fracture of C-2 (Odontoid process)
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: Lateral C-Spine X-Ray
Fracture of the
odontoid
Posterior
tubercle of Atlas
Vertebral body
of C6
IV disc space
CLINICAL INDICATION: Pain in neck after
falling down steps.
REPORT: There appears to be a transverse
fracture at the base of the dens with
subsequent anterior shift of the C1 vertebra
and the skull. The anterior shift in the C1
vertebra indicates a possible impingement of
the spinal cord. Degenerative disc narrowing
is also noted at C3-4, C4-5 mad C5-6
CONCLUSION: There is a Type ll Fracture of
the C2 Odontoid process causing and anterior
shift of the C1 vertebra indicates a possible
impingement of the spinal canal.
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
 Non-operative means are contraindicated
due to the unstable fracture.
 Type II fracture indicated internal fixation
as the primary management.
 A fusion of the C1 and C2 vertebrae is
created using wire and midline bone grafting.
70 year old male is experiencing
pain & lower extremity paralysis
Diagnosis:
Multiple Metastatic Lesions
8
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: CT of Thoracic spine
CLINICAL INDICATION: Back pain and lower
extremity paralysis
REPORT: Red arrows show area of
destructive lesions protruding posteriorly
from the vertebral canal to the spinous
processes.
CONCLUSION: Multiple metastatic lesions
are impinging on the nerves and spinal
cord which leads to lower extremity
paralysis and pain experienced by the
patient.
8
Vertebral body
Spinous process
of Thoracic vertebra
Rib
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
Management of metastatic lesions could
include either radiation therapy, removal of
the tumors through open surgery or
Percutaneous Inage-Guided Vertebral body
Augmentation. Radiation and open surgery
are the two most common treatments.
Radiation offers a non-invasive, less
immediate risk option. Percutaneous ImageGuided Vertebral Body Augmentation uses
bone cement to relieve pain from spinal
tumors and stabilizes the spine. It is
considered less-invasive that open surgery.
8
25 year old male with
neck pain following
MVA
Diagnosis: C5 fracture
9
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
RADIOLOGY EXAM: Lateral C-Spine x-ray
CLINICAL INDICATION: Neck pain following MVA
Spinous
process
Fragmented anterior portion
of vertebral body
Aligned
facet joint
REPORT: Fracture of the anterior portion of the
C5 vertebral body. There is widening of facet
joints and interspinous spaces of the C5 cervical
vertebra.
CONCLUSION: C5 fracture
Widened
facet joint
Trachea
9
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
 Fractures of this type are loosely referred
to as “tear-drop” fractures based of
appearance of the triangular displaced
vertebral body portion.
 Anterior column trauma may be result of
axial loading injuries including a combination
of extreme compression, extension, flexion, or
rotational events.
 Often, anterior spinal injuries accompany
loss of motor function, temperature
sensation, pain but maintaining
proprioception.
9
SPINE CASE #10
Patient goes to the doctor with
Complaint of back pain.
Please Study the images-add
Your diagnosis and return to me @
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis--Kypho-scoliosis
10
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: AP & Lateral Chest.
Clavicle
CLINICAL INDICATION: Back pain
Scoliosis and kyphosis
of the thoracic spine
REPORT: Ap x-ray shows curvature of the
thoracic spine indicative of scoliosis
concave to the left at T-9.
Lateral x-ray shows an exaggerated
primary kyphotic curv of the thoracic
spine.
Diaphragm
CONCLUSION: Kyphotic scoliosis
IV disk space
10
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confirm the diagnosis and /or other abnormalities.
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Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
Patient can undergo surgery for spinal
decompression and spinal fusion with
brackets and screws.
10
33 year old truck driver goes to the
Health center for his required DOT
physical as a new employee.
Diagnosis: Bifid spinous processes
C-7, T-1 & T-2
11
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confirm the diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: Frontal Chest X-ray
Clavicle
Bifid spinous
processes
CLINICAL INDICATION: Required Physical
REPORT: Spina Bifida Occulta in Spinous
Processes of C7, T1, and T2
Normal
spinal process
Lt. 4th rib
CONCLUSION: see report
INTERPRETER’S NAME_______________
DATE______________
11
Three bullet points about pathology
identified
OR
Management of the identified process
50 words or less
Spina bifida occulta occurs when lamina do
not merge during development, thus creating
a bifid spinous process.
Twenty –five percent of the population has
this abnormality, but it is generally
asymptomatic.
 The meninges and spinal cord are generally
not affected due to this defect alone.
11
A 50 year old man goes to his general
physician with the complaint of a sore
throat x 2 weeks.--- A soft tissue lateral
neck x-ray was done.
Diagnosis: Segmentation anomaly
of C5/6
12
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
RADIOLOGY EXAM: Soft tissue lateral neck
C2 Spinous
Process
C3 vertebral body
Hyoid bone
Fused vertebral bodies
CLINICAL INDICATION: Sore throat x 2
weeks
REPORT: Fusion of vertebral body C5-6
with bony bridge across the disc space.
Transverse and spinous processes appear
normal and healthy. No visible fractures,
possible edema of the anterior soft tissue
at level of C5-C6, no apparent IV disk
between C5-C6 mainly bone present
CONCLUSION: Segmentation Anomaly of
C5-C6
12
Three bullet points about pathology
identified
OR
Management of the identified process
50 words or less.
Congenital
Defective segmentation of the developing
tissue within the spine

Administer anti-inflammatory medication to
help with sore throat.
12
50 year old man falls from a ladder
CT scans done in the emergency room.
Diagnosis: Compression fracture
of T-12
13
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
Fracture of T12
vertebral body
RADIOLOGY EXAM: CT scan of thoracic spine
CLINICAL INDICATION: Trauma-Lower back
pain
Compression
fx of T-12
REPORT: Sagittal CT scans reveal decrease in
the height of the vertebral body of T12. Axial
Scans reveal fracture lines in the vertebral
body of T12
Normal
vertebra
CONCLUSION: Axial and sagittal CT scans
reveal compression fracture of the T12
vertebra. Retropulsion of fragments into the
spinal canal is also evident.
Costo-vertebral
joint
Facet joint
13
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
The most common compression fracture
occurs in the T-12 vertebra.
The result of a compression fracture is a
wedge-shaped appearance to the vertebral
body.
A radiographic decrease of 20% or more or
a decrease in height of the vertebral body by
4mm compared with the baseline height
confirms compression fracture.
13