Interpretation of Neymar's CT L spine

[soulofmpatel]

In the quarter final world cup game on 7/4 (Brazil vs. Columbia), the Brazilian striker Neymar was kneed in the back for a free kick.

This occurred late in the game in the game with Brazil leading 2-1, so Neymar was incentivised to fake injury to kill time. Neymar is also known for diving and faking injuries.

here is a clip of the foul

[media]

Although this is a clear foul, I couldn't help but think that the velocity of the opponents knee did not appear sufficient to cause serious injury.

Neymar was carried of the field in obvious pain and did not play the remainder of the game, but Brazil held 2-1 to advance to the Quarter finals against Germany.

it was shortly after reported that Neymar had suffered a "vertebra fracture" and would not play in the remainder of the matches.

A parasagittal CT image subsequent went viral:

Obviously, this is just a single image, but the margins of the L3 pedicle defect appear sclerotic and chronic. Is this a true fracture or just a congenital pars defect or old healed fracture unrelated to the injury?

Also, in the video, it appears that the contact occurred in the lower thoracic area rather than the Lumbar area.

What are you thoughts

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[cowme]

Hard to say on a single image, but there's a lot of soft tissue density at that foramen compared to the levels above and below, which would favor acute

Also gotta go with clinical context. The dude had trauma to his back in an awkward position, and was in bad enough pain to get carted off and get a CT.

 

[colbgw02]

Well, that's not a pedicle defect. As you say, it's the pars. Besides, haven't news outlets reported it was a spinous process fracture? Shockingly, I think the image is a fake.

Also, I think your level is off. I doubt that's L3 based on the lumbosacral promontory.

Lastly, while spondylolyses have a hereditary component, I don't think they're congenital.

 

[shark2000]

This has all the components of "stress fracture of pars interarticularis" and appears acute.

Stress fracture of pars interarticularis occurs in young athletes and is relatively common.

This fracture is acute since there are sharp borders into it and there appears to be surrounding fat stranding/soft tissue swelling (not the best window).

You are right. There is sclerosis in the pars interarticularis because it is the stress reaction. Under stress first you see periosteal reaction plus sclerosis in the involved bone. If the stress continues or if an acute injury superimposes, then the bone fractures.

 

[Hackerboy]

This is a chronic spondylolysis with the sclerosis present, with no bearing whatsoever on the acute injury reported. I suspect the actual images of the acute injury have not been released.

 

[soulofmpatel]

Interesting. There is some difference of opinion, but it seems that there is some agreement that this is at least in part a chronic process.

I guess what made me suspicious is that the collision itself appears insufficient to cause a fracture, but perhaps this makes sense if he had a chronic underlying pars stress fracture.

here is a link to the video as the above embedding didn't work