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Avascular Necrosis of Spine: A Rare Appearance

Maheshwari, Praveen R., MD*; Nagar, Arpit M., DMRD*; Prasad, Shashank S., DMRD; Shah, Jeshil R., MD; Patkar, Deepak P., MD

doi: 10.1097/01.BRS.0000115139.07685.EE
Case Report
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Study Design. Avascular necrosis (AVN) of two contiguous vertebrae along with the intervening disc is presented.

Objectives. AVN of two contiguous vertebrae and the intervening disc is a rare entity and can be confused with infective and neoplastic processes. We present the role of magnetic resonance imaging (MRI) in the diagnosis of AVN.

Summary of Background Data. AVN of vertebral bodies is a known entity; however, involvement of two contiguous vertebrae along with the intervening disc is atypical. The imaging features can be confused with an infective etiology, which involves the disc more commonly as compared to AVN. Neoplastic destruction of vertebrae also needs to be ruled out in appropriate clinical situations.

Methods. Frontal and lateral radiographs of the lumbar spine were performed followed by an MRI. Subsequently CT-guided fine needle aspiration cytology was performed.

Results. These radiographic features were correlated with the clinical and pathologic findings. The MRI findings of a wedge-shaped lesion with classic fluid intensity (hyperintense signal, like that of cerebrospinal fluid on T2-weighted images) are characteristic of AVN. Fine needle aspiration cytology confirmed the diagnosis and excluded an infective or a neoplastic process.

Conclusions. The MRI findings described in this report are very characteristic of AVN of spine. Clinical and radiologic correlation could help in making the diagnosis and avoid unnecessary investigations.

Avascular necrosis of the vertebral body is a rare entity with few cases described in the literature. The majority of cases are secondary to traumatic compressive fractures. We describe the imaging findings of avascular necrosis of lumbar vertebrae in a middle-aged woman, presumed to be sequela of osteoporotic wedge compression fracture. Affection of the superior surface of adjacent vertebral body and the intervening disc is an atypical feature, seen in this case.

*Department of Radiology, K.E.M. Hospital, and the

†Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, India.

Acknowledgment date: May 21, 2003.

First revision date: July 25, 2003.

Acceptance date: August 29, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Praveen Maheshwari, MD, A-10, Century Staff Qts, Near TV Center, P.B. Marg, Worli, Mumbai-400025, India; E-mail: praveenparikshitdas@rediffmail.com

© 2004 Lippincott Williams & Wilkins, Inc.