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Educational

Series

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Welcome to Rayence Educational Series in partnership with Drs. Terry R. Yochum and Alicia M. Yochum.

Images from radiology practice submitted by Chiropractors throughout the United States will be displayed here with a review and basic description provided by Drs. Terry and Alicia Yochum! This is intended to be a brief discussion with a select group of images so the doctor can review them in a short period of time and learn what the experts see in those images.

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Case History


A 59-year-old female patient is complaining of lower back pain that has lasted four days. There is no previous history of back pain, cancer, or surgery. All three of her children were delivered via C-Section. At present, the patient’s low back pain is constant.



Discussion


Observe the severe anterior displacement of L5 upon the sacral base representing “spondyloptosis”. The vertebral body of L5 is triangular in its position which is an adaptation to the patient’s longstanding presence of spondylolisthesis of a “Grade V” nature (multiple arrows outlining the L5 vertebral body). There is no disc space left between the L5/S1 level. There is a rounding off of the anterior surface of the sacrum which has been referred to as “doming”. There is a curvilinear appearance on the area of the sacral base on the frontal projection which has been referred to as the “Bow Line of Brailsford.” This curvilinear radiopacity represents the L5 vertebral body superimposed on the sacral base (multiple arrows outlining the vertebral body of L5).

Also notice, there is an old, healed compression fracture with depression of the superior vertebral endplate of L2.


Comment


Be assured, patients with Grade V spondyloptosis have had their spondylolisthesis since early childhood. It’s amazing that this patient has no neurological deficit nor symptoms of radiculopathy. Years ago, if a woman was pregnant with the appearance of spondyloptosis, a Cesarean Section would have been an immediate conclusion. I have seen more than one case, with this degree of spondyloptosis, where a child has been born naturally through the pelvic canal. Of course, that patient should not deliver with a midwife or have a home birth; that patient should be in the hospital in case emergency care is necessary. In conclusion, I believe this patient’s back pain is unrelated to the advanced spondyloptosis of L5.


Courtesy of the Livesay Chiropractic Clinic, Johnson City, TN


Reference


Yochum & Rowe, Essentials of Skeletal Radiology, 3rd Edition, Lippincott, Williams and Wilkins, Chapter 5, 2005

Updated: May 25

Case History


This is 47 year old male patient complaining of lower back pain without radiculopathy.


Diagnosis


Observe the calcification within the vas deferens which diverges from the midline above the pubis in a tubular pattern. On occasion the vas deferens can be traced along its course through the inguinal canal to the scrotum. This calcification is benign in nature and actually pathognomonic for diabetes. It is somewhat unusual for a patient of this young age to have vas deferens calcification. No further imaging of this is necessary and this is not thought to be symptom generating.


Reference


Yochum & Rowe, Ch. 18, Masqueraders of Musculoskeletal Disease, 3rd ed., 2005

Case History


This 70-year-old male patient complains of lower back and right hip pain, measured at 3/10. Occasionally, the patient experiences symptoms of radiculopathy down the right leg.



Radiographic Findings


Observe the sclerotic appearance of the dome of the sacral promontory. This sclerotic appearance is unrelated in osteoblastic activity from neoplasm but rather a stress related phenomenon. The disc space narrowing at the L5/S1 level is advanced placing a significant amount of stress upon the anterior sacral promontory, which allows subchondral degenerative sclerosis to occur. Notice, there is a double degenerative spondylolisthesis with a slight anterior displacement at L3 upon L4 and L5 upon the sacrum. Degenerative spondylolisthesis has been defined by Hadley as spondylolisthesis with an intact neural arch. Degenerative spondylolisthesis is seen most frequently in females over the age of 40 and often obese. This follows the “3 F signs” of degenerative spondylolisthesis: Females over Forty and Fat (apology offered). Note also, mild atherosclerosis present in the abdominal aorta.


Reference


Yochum and Rowe, Essentials of Skeletal Radiology, Masqueraders of Musculoskeletal Disease, Chapter 18 Lippincott, Williams and Wilkins, 2005.