1. What is the key finding which likely explains the patient's symptoms?
There is unilateral right sided marrow hyperemia within the right L5 pedicle. This most likely represents an acute stress reaction within the pedicle with no evidence of fracture at this time.
2. What additional findings are present?
At L4-5 there is a grade 1 degenerative anterolisthesis of L4. Facet arthrosis and disc bulges are noted at L4-5 and L5-S1.
3. What are some causes of unilateral pedicle marrow edema?
Stress reaction is one of the more common causes of unilateral pedicle edema. This may be related to physical activity and is not uncommon in adolescent athletes, especially in sport activities that require repetitive twisting motions such as baseball or tennis. Unilateral stress reaction in a pedicle may be seen in adolescent patients with scoliosis. The presence of a unilateral pars defect producing spondylolisthesis may produce stress related marrow edema in the contralateral pedicle which may result in a stress fracture. Some neoplastic conditions, such as osteoid osteoma for instance, will have marrow hyperemia as an associated finding.
4. What are the treatment options?
Once a diagnosis of stress related marrow change is made care must be initiated to prevent progression to a stress fracture. Initial rest, pain management, and appropriate bracing in coordination with chiropractic and physical therapy to address patient biomechanics and correct training errors which may have predisposed the patient to abnormal stress. Failure of the patient to comply to treatment or failure to initiate treatment in a timely manner may result in the development of a stress fracture which may require more advanced corrective procedures such as surgery to stabilize the spine.
There is unilateral right sided marrow hyperemia within the right L5 pedicle. This most likely represents an acute stress reaction within the pedicle with no evidence of fracture at this time.
2. What additional findings are present?
At L4-5 there is a grade 1 degenerative anterolisthesis of L4. Facet arthrosis and disc bulges are noted at L4-5 and L5-S1.
3. What are some causes of unilateral pedicle marrow edema?
Stress reaction is one of the more common causes of unilateral pedicle edema. This may be related to physical activity and is not uncommon in adolescent athletes, especially in sport activities that require repetitive twisting motions such as baseball or tennis. Unilateral stress reaction in a pedicle may be seen in adolescent patients with scoliosis. The presence of a unilateral pars defect producing spondylolisthesis may produce stress related marrow edema in the contralateral pedicle which may result in a stress fracture. Some neoplastic conditions, such as osteoid osteoma for instance, will have marrow hyperemia as an associated finding.
4. What are the treatment options?
Once a diagnosis of stress related marrow change is made care must be initiated to prevent progression to a stress fracture. Initial rest, pain management, and appropriate bracing in coordination with chiropractic and physical therapy to address patient biomechanics and correct training errors which may have predisposed the patient to abnormal stress. Failure of the patient to comply to treatment or failure to initiate treatment in a timely manner may result in the development of a stress fracture which may require more advanced corrective procedures such as surgery to stabilize the spine.