Multilevel “fish-vertebra” sign in a patient with idiopathic osteoporosis
A 50-years-old male with a history of waist and lower back pain for over a year who initially treated with non-steroidal anti-inflammatory drugs (NSAIDs), modification on activities of daily living and physical therapy protocols-exercises presented to our department. A thorough history revealed that he was employed in an environment with work related musculoskeletal disorder risks, with no significant prior traumatic medical or surgical experience and medication history (free history of previous long-term corticosteroid drugs). The pain had increased during the last 4 weeks without any remarkable improvement in symptoms after a combination of NSAIDs and opioid drugs. His pain was more intense when bending forward and was relieved on recumbent position. Neurovascular examination was normal.
Sagittal T2-weighted MRI of the thoracolumbar spine resembling the characteristic “fish-vertebra” sign. All the vertebral bodies from T12 to L5 show the biconcave vertebral body deformity of their endplates, with different signal intensities of their bone marrow and loss of more than 30% of the vertebral height.