PMC9258736_01
(A) Sagittal STIR and (B) T2 MR images of the lumbar spine, and (C) transverse T2 MR image at the level of mid-L5. Notice the diffuse hyperintensity of the vertebral structures (asterisks), associated with circumferential concentric bone thickening, and secondary narrowing of the vertebral canal (white arrows) leading to circumferential compression of the spinal cord. The nucleus pulposus is also decreased in intensity at L7-S1, and the annulus fibrosus protrudes dorsally in the vertebral canal.
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F1
T2 signal (Figure 1) with diffuse and homogenous contrast enhancement (Figure 2). There was complete circumferential attenuation of the CSF signal surrounding the spinal cord at this level (Figure 1).
Sagittal T1 weighted (A) pre and (B) post contrast MR images of the lumbar spine, and (C) corresponding subtraction image. (D) Transverse T1 weighted pre and (E) post contrast MR images at the level of mid-L5 and (F) corresponding subtraction image. Notice the diffuse hyperintensity, homogeneous enhancement of the vertebral structures, associated with circumferential concentric bone thickening, and secondary narrowing of the vertebral canal (white arrows) leading to circumferential compression of the spinal cord. Similar changes are noted at L4 and L6.
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F2
T2 signal (Figure 1) with diffuse and homogenous contrast enhancement (Figure 2).
(A) Right lateral radiographs of the thoracolumbar and (B) lumbosacral spine. T13 has the last pair of ribs. Notice the new bone formation around the spinous process of T11 and T12 and the articular processes at T11-12 and T12-13. The lumbar vertebrae appear decreased in radiopacity, and the dorsal cortex of the vertebral bodies is not identified. There is ventral bridging spondylosis along the ventral aspect of the lumbar spine, from L3 to LS (ventrally to the endplates but extending ventrally to the vertebral body as well) causing a flowing ossicification consistent with diffuse idiopathic skeletal hyperostosis (DISH). There is further ventral bridging spondylosis at the level of T7-T8 and T9-T11.
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F3
Right lateral radiographs of the vertebral column from T6 to Cd2 (Figure 3) showed normal to decreased bone radiopacity of the lumbar vertebrae, and loss of visualisation of the dorsal cortex of the vertebral body from L1 to L6.
Post-mortem specimen; transverse section at the level of mid-L5 vertebral body. Note the concentric narrowing of the vertebral canal, as well as the hyperostosis and smooth osseous proliferation of the articular surfaces.
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F4
On gross necropsy the lumbar vertebrae were thickened (hyperostosis), with the articular surfaces covered in smooth osseous proliferation (Figure 4).