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An unusual cause of back pain

BMJ 2009; 338 doi: (Published 29 January 2009) Cite this as: BMJ 2009;338:a3183
  1. I Davagnanam, fellow in neuroradiology1,
  2. S Harave, specialist registrar in radiology2
  1. 1Department of Neuroradiology, Kings College Hospital, London SE5 9RS
  2. 2Department of Radiology, Queen Alexandra Hospital, Portsmouth PO6 3LY
  1. Correspondence to: I Davagnanam Indran_davagnanam{at}

    A 26 year old man with no relevant medical history presented to his general practitioner with an 18 month history of progressive chronic back pain. He had difficulty walking long distances, with progressive pain and weakness in his legs, and had experienced erectile dysfunction in recent months. He was referred to a neuroscience centre for further evaluation, which confirmed the clinical findings and documented a clinical loss of perianal sensation.

    His body mass index was 29.8 (normal range: 18.50-24.99). He was not on exogenous steroids and had no clinical signs or symptoms of Cushing’s disease.

    Magnetic resonance imaging of the lumbar spine was performed (figs 1 and 2).

    Fig 1 Sagittal T1 weighted image of the lumbosacral spine

    Fig 2 Sagittal T2 weighted image of the lumbosacral spine


    • 1 In which spinal compartment is the abnormality located?

    • 2 Describe the abnormality?

    • 3 What is the most likely diagnosis?


    Short answers

    • 1 The epidural space.

    • 2 The patient has extensive fat deposition in the epidural space, which results in …

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