Diagnostic Imaging Case Report: A 39-year-old female reports with chronic back pain

Hello.  My name is Jack Henry, DC, DACBR.  I am Radiologist-in-Chief of Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses.  All of our services are provided at no cost to doctor and  no/low cost to patients.

Selected cases will be presented for your evaluation.  The studies may or may not have abnormalities.  Use the arrow keys or the scroll bar to carefully evaluate the films.

Step 1:  Is the study abnormal or normal?

Step 2:  If the study is abnormal, what is your best diagnosis?

Step 3:  Which follow-up imaging option would be best?

Step 4:  Compare your results with the correct diagnosis.

HISTORY

A 39-year-old female reports with chronic back pain of many years. The patient’s past medical history and physical examination findings were not provided at time of formal image interpretation.

FINDINGS

The study is negative for acute fracture or dislocation. There is a shallow, right convexity of the thoracolumbar spine. Please note the erosive changes involving the neural arch structures at the T11, T12, and L1 levels. There is subtle posterior scalloping at these levels as well.


DISCUSSION

The findings noted and described above are consistent with underlying dural ectasia. In my experience, the dural ectasia cases I have seen were commonly associated with neurofibromatosis. However, the literature notes Marfan syndrome and Ehlers-Danlos syndrome as common culprits. Chiropractors must take heed due to the compromised neural arch bony integrity associated with this condition. Bowel and bladder dysfunction should be thoroughly investigated.