Hello. My name is Jack Henry, DC, DACBR. I am Radiologist-in-Chief of
Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses. All of our services are provided at no cost to doctor and no/low cost to patients.
Selected cases will be presented for your evaluation. The studies may or may not have abnormalities. Use the arrow keys or the scroll bar to carefully evaluate the films.
Step 1: Is the study abnormal or normal?
Step 2: If the study is abnormal, what is your best diagnosis?
Step 3: Which follow-up imaging option would be best?
Step 4: Compare your results with the correct diagnosis.
HISTORY
A 27-year-old male reports low back pain on and off for the last three years. The patient has seen four different chiropractors and a physical therapist with “mixed results”. Orthopedic and neurological exams were within normal limits.
FINDINGS
The study is negative for acute fracture or dislocation. The L5 disc is narrowed. However, this is felt to be second to hypoplasia. On close inspection, please note bilateral and symmetrical fibrous bony ankylosis of the SI joints. In addition, there is subtle “squaring” of the lumbar vertebrae best visualized at L5. No evidence of syndesmophytic formation is apparent.
DISCUSSION
Sero negative spondyloarthropathies are relatively common and are often missed or misdiagnosed by chiropractors and other primary clinicians. The cyclic nature of the process leads to confusion by the attending and the possibility of inappropriate care.
FOLLOW UP PROTOCOL
This case most likely represents AS. A consultation with a rheumatologist is recommended as an immediate follow-up.