Differential Diagnosis

The patient's MRI findings suggest a complex spinal injury with both traumatic and degenerative components. The following differential diagnoses are considered:

• Single most likely diagnosis:
  • Traumatic spinal injury with unstable extension-distraction fracture at T11-T12 level, resulting in spinal canal stenosis and potential neural compromise. This diagnosis is most likely due to the presence of a traumatic 6 mm retrolisthesis of L1 over T12 vertebral body, mildly displaced fracture of the anterior inferior T12 vertebral body, and suspected focal disruption of the ligamentum flavum at T11-T12 level.
• Other Likely diagnoses:
  • Degenerative lumbar spondylosis with spinal canal stenosis at multiple levels (L3-L4, L4-L5), contributing to the patient's symptoms.
  • Post-traumatic epidural hematoma, although the current hematoma is described as equivocal and thin (up to 3 mm in maximal thickness).
  • Ligamentous injury, including disruption of the ligamentum flavum and interspinous ligamentous injury at T10-T12 level.
• Do Not Miss:
  • Spinal epidural abscess: Although the current MRI shows only an equivocal thin ventral epidural hematoma, the presence of any epidural collection warrants consideration of an abscess, which would require urgent medical attention.
  • Cauda equina syndrome: The severe spinal canal stenosis at L4-L5 level with compression of the cauda equina nerve roots increases the risk of cauda equina syndrome, a potentially devastating condition requiring prompt intervention.
  • Spinal cord injury: Although no definite cord signal abnormalities are noted, the presence of spinal canal stenosis and unstable fracture at T11-T12 level necessitates careful evaluation for potential spinal cord injury.
• Rare diagnoses:
  • Spinal cord infarction: Although less likely, the patient's traumatic injury and potential disruption of spinal cord blood supply may increase the risk of spinal cord infarction.
  • Infectious spondylodiscitis: The presence of degenerative changes and traumatic injury may increase the risk of infectious spondylodiscitis, although this diagnosis is less likely without additional clinical or laboratory evidence.