Pedicle lesion?

[Baron Samedi]

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Asking for a colleague. Young patient, in his 20s, focal left-sided low back pain approx L3. His 2018 only demonstrated an L3 subcentimeter T2 hyperintense lobulated lesion, likely benign. Continues to have pain 2 years later and current MRI looks as below. I appreciate it less on recent imaging but can still appreciate subtle T2 hyperintensity on the pedicle. Different radiologist didn't call anything this time(I probably wouldn't have noticed anything if I didn't know the history).

Little doubt it's benign given unchanged appearance over 2 years. Question is -- any chance its an actual pain generator? My thought is probably not, but his pain location does apparently correspond to the location. If so, what to do about it?

 

[SSdoc33]

Asking for a colleague. Young patient, in his 20s, focal left-sided low back pain approx L3. His 2018 only demonstrated an L3 subcentimeter T2 hyerintense lobulated lesion, likely benign. Continues to have pain 2 years later and current MRI looks as below. I appreciate it less on recent imaging but can still appreciate subtle T2 hyperintensity on the pedicle. Different radiologist didn't call anything this time(I probably wouldn't have noticed anything if I didn't know the history).

Little doubt it's benign given unchanged appearance over 2 years. Question is -- any chance its an actual pain generator? My thought is probably not, but his pain location does apparently correspond to the location. If so, what to do about it?

its not impossible. rest of the MRI looks clean. agree that i am not sure what to do about it. id be tempted to MBB that level, but i wouldnt love to burn in a 20-something. if he is really struggling, then an RF isnt out of the realm.

i wonder if there is a different MRI study. MRI with contrast? one of those CT spect scans? this is something that radiology could help with in terms of a better imaging study

 

[chibadriver]

Is this a non-displaced fracture? CT would be more informative. Maybe target the L2/3 facet if you are considering an intervention, but I think an ESI is not unreasonable even without radicular symptoms.

 

[lobelsteve]

its not impossible. rest of the MRI looks clean. agree that i am not sure what to do about it. id be tempted to MBB that level, but i wouldnt love to burn in a 20-something. if he is really struggling, then an RF isnt out of the realm.

i wonder if there is a different MRI study. MRI with contrast? one of those CT spect scans? this is something that radiology could help with in terms of a better imaging study

Getting a bone scan should help out tremendously

 

[Orin]

Agree a CT-SPECT could help greatly. I might also look for a fat suppressed T2 or STIR seq on the MRIs as that may better show bony edema/stress in the pedicle.

 

[chudat]

night time pain? Agree bone scan is good start.