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CASE OF THE WEEK 84 Courtesy of Michelle Wessely DC, DACBR and Tim Mick, DC, DACBR Minnesota, USA.
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CASE OF THE WEEK 84Courtesy of Michelle Wessely DC, DACBR and Tim Mick, DC, DACBRMinnesota, USA A 52-year-old male with a sit down type fall recently, resulting in severe back pain, centered around L1. There is also a history of “long-standing” prior trauma related to a motorcycle accident, with no focal upper lumbar pain at that time.
What are the abnormal findings? What is/are the diagnoses? What is the clinical significance?
Answers • Abnormal findings: Multiple focal round soft tissue densities. Loss of anterior and posterior body height of L1 with retropulsion in to central canal. • Diagnosis: Neurofibromatosis (NFT) Recent burst-type fracture of L1 • Clinical Significance: NFM patients have reduced bone density, as well as multisystem abnormalities such as vascular, optic, osseous and cutaneous lesions. Recent burst-type fracture of L1 may be associated with neural compromise and MR imaging is indicated to evaluate.
Additional information on this patient • He was aware of his NFT before presenting to the chiropractor in Minnesota. • His left lower limb had been amputated (did you catch this on the AP lumbopelvic radiograph?)! This is likely to a history of focal gigantism, whereby a region, usually a finger or toe is hypertrophied.