4.0 of 94 Ratings
A 74-year-old female presents with complaints of persistent back pain for the past 2 months. She reports sustaining a fall down the stairs 10 months prior and was initially seen in the Emergency Department where imaging was obtained (Figure A). She was managed with rest and physical therapy. Following initial conservative management, she reported improvement in symptoms until the past 2 months. She denies any new injury. Figures B-D represent the MRI images obtained one week ago. What is the most likely etiology for her persistent back pain?
Infection in the disk or the vertebral body
Intravertebral disc herniations
Post-traumatic vertebral body osteonecrosis
Vertebral body nonunion
Select Answer to see Preferred Response
Figure A depicts the radiograph of a 76-year-old woman who sustained a mechanical fall. On examination, she has no fevers, chills, or neurological deficits. She has no history of malignancy and CT does not demonstrate any metastatic lesions. Which of the following statements is true regarding her underlying metabolic bone condition and associated fracture?
The underlying metabolic bone condition is characterized by abnormal bone quality
The underlying metabolic bone condition is characterized decreased bone quantity
A thoracolumbosacral orthosis is strongly recommended if nonoperative management is elected
Bisphosphonates are indicated to treat the underlying metabolic bone condition if a DEXA scan shows a T-Score of -1.0 to -1.5
Kyphoplasty is indicated as a first line of treatment for the associated fracture if the pain is severe enough to warrant narcotics
A 75-year-old patient presents with severe back pain after sustaining an osteoporotic vertebral compression fracture 4 months ago. The patient continues to have debilitating pain that prevents normal activities of daily living despite the use of bisphosphonates, anti-inflammatory pain medications, and bracing. Figures A and B are CT scan images of the lumbar spine. What is a reasonable treatment option at this time?
Continued conservative management
Anterior corpectomy and fusion
Posterior spinal fusion
A morbidly obese 80-year-old woman presents with back pain for 2 months. Sagittal T2-weighted, sagittal T1-weighted, coronal short tau inversion recovery (STIR) images are shown in Figures A through C, respectively. Which of the following statements is true of her diagnosis?
MR fluid sign suggests that this is an osteoporotic vertebral compression fracture
Convex posterior vertebral border suggests that this is an osteoporotic vertebral compression fracture
Replacement of the normal marrow signal suggests that this is a malignant vertebral compression fracture
Retropulsion of a vertebral body fragment suggests that this is a malignant vertebral compression fracture
The band-like low T1 signal suggests that this is a malignant vertebral compression fracture
A 66-year-old Caucasian female presents to the ER with severe new low back pain after she slipped on the curb yesterday night. You see her 3 hours after admission, and two hours after she was given 5 mg of oxycodone. She states she had no back pain prior to the fall, and a CT scan of the abdomen obtained 2 months earlier for abdominal pain demonstrated no evidence of a fracture. Her past medical history is significant for hypertension and hyperlipidemia. On physical exam she has 5/5 strength in all major muscle groups, normal sensation, 1+ patellar and achilles reflexes, no clonus and a down-going Babinski sign. While it causes her significant pain, she is able to stand and walk to the exam room door and back. A lateral radiograph is seen in Figure A. What would be the most appropriate first line of treatment.
Thoracolumbar Custom Orthosis (clamshell brace)
Opioids for pain control with gradual activity such as walking with no restrictions
NSAID therapy alone, strict bed rest for 7 days, followed by structured physical therapy
Calcitonin therapy alone, strict bed rest for 7 days, followed by structured physical therapy
A 79-year old female sustains a low energy fall and is hospitalized for low back pain that prevents her from ambulating. She denies any symptoms of buttock or leg pain. On physical exam she has point tenderness over the T12 vertebral body. Examination of her lower extremities is normal. Radiographs are shown in Figure A and B. An MRI is performed which shows signal intensity within the T12 vertebral body on T2-weighted images and no evidence of retropulsion or spinal cord compression. Which of the following statements is true regarding this injury pattern?
There is no association between this fracture and future osteoporotic fragility fractures.
Prospective, randomized, double blinded studies have recently showed improvement with vertebroplasty.
2-year mortality rates are roughly equivalent to those associated with hip fractures.
This fracture results in chronic back pain in the majority of patients regardless of treatment.
Neurologic deterioration is a common complication with this injury pattern.
In the treatment of acute osteoporotic compression fractures, vertebroplasty has been shown to have which of the following benefits in randomized, double-blind, placebo-controlled trials compared to nonoperative treatment.
Improvement in pain at 3 months, but not difference at 1 year
Improvement in function at 3 months, but not difference at 1 year
Improvement in pain at 2 week and at 1 year, but no difference in function
Improvement in pain and function at all time points
No benefit at any time point
A 71-year-old female who has no significant medical comorbidities presents to the emergency department after sustaining a compression fracture of L2. The patient has moderate back pain but is neurologically intact. Radiographs of the entire spine reveal a L2 compression fracture with 30% loss of vertebral body height loss and 15 degrees of local kyphosis. What would be the appropriate management for this patient?
Bedrest for ten days
Oral pain medications, thoracolumbosacral orthosis, and progressive increase in activity level
Posterior percutaneous pedicular fixation from L1 to L5
Posterolateral fusion from L2 to L4 with instrumentation
Anterior column reconstruction with strut grafting and plate fixation