J Korean Soc Spine Surg.  2007 Jun;14(2):115-119. 10.4184/jkss.2007.14.2.115.

Congenital Absence of a Pedicle of L4 in the Spinal Stenosis: A Case Report

• Kim YI
• Lee JC
• Choi WS
• Shin BJ

• KMID: 1941665
• DOI: http://doi.org/10.4184/jkss.2007.14.2.115

Abstract

Congenital absence of a lumbar pedicle is an uncommon anomaly, and most cases are asymptomatic and discovered incidentally. A 72-year-old man presented with lower back pain that radiated to his bilateral lower extremities. Physical examination revealed no neurological deficits. Plain radiographs of the lumbar spine revealed absence of the left L4 pedicle, along with hypertrophy and sclerosis of the contralateral pedicle. Magnetic resonance imaging showed stenosis of the L3-4 neural canal. Computed tomography revealed absence of the left L4 pedicle associated with hypertrophy and sclerosis of the right L4 pedicle and facet joint. The symptoms of the patient were resolved after posterior decompression without fusion. Here, we report one case of congenital absence of an L4 pedicle detected in a spinal stenosis patient who need to undergo a decompressive surgery for the spinal stenosis caused by contralateral facet hypertrophy.

Keyword

Congenital absence of pedicle; Lumbar; Spinal stenosis; Posterior decompression

MeSH Terms

Aged
Constriction, Pathologic
Decompression
Humans
Hypertrophy
Low Back Pain
Lower Extremity
Magnetic Resonance Imaging
Neural Tube
Physical Examination
Sclerosis
Spinal Stenosis*
Spine
Zygapophyseal Joint

Figure

• 

  Fig. 1. Preoperative AP (A) and lateral (B) radiographs of a 72-year-old man suffering from spinal stenosis at L3-4 level. Arrow indicates absence of the left L4 pedicle.

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  Fig. 2. CT scans shows absence of the left pedicle and hypertrophy of the right pedicle of L4 vertebra. Degenerative changes of the right L4-5 facet joint was also noted. Arrow indicates the rudimentary bony connection between the vertebral body and the left side transverse process, instead of the pedicle.

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  Fig. 3. Three-dimensional (A) & 2-D (B) reconstructed CT image shows absence of the left pedicle at L4 (arrow-pointed).

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