Intended for healthcare professionals

Endgames Spot Diagnosis

A plain radiograph in back pain

BMJ 2016; 355 doi: (Published 06 October 2016) Cite this as: BMJ 2016;355:i5003
  1. Joseph Dalby Sinnott, core surgical trainee1,
  2. David C Howlett, consultant radiologist2
  1. 1department of surgery, East Sussex Hospitals NHS Trust, Eastbourne, UK
  2. 2department of radiology, East Sussex Hospitals NHS Trust
  1. Correspondence to: J D Sinnott j.d.sinnott{at}

A 35 year old man presented to his general practitioner with lower back pain that was getting progressively worse. The pain was now severe enough to wake him in the night. What does the radiograph show (fig 1) and what is the diagnosis?

Fig 1


The radiograph shows multiple signs pointing to …

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