CASE OF THE WEEK 84 Courtesy of Michelle Wessely DC, DACBR and Tim Mick, DC, DACBR Minnesota, USA

1. 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.

2. What are the abnormal findings? What is/are the diagnoses? What is the clinical significance?

3. 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.

4. 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.