Note: In this series, I will discuss the direct patient-to-radiologist consult experience from real patients seen at Lightbulb Radiology. The names (and some details of the clinical history) have been changed for purposes of anonymity. All of these cases are presented with the patient’s permission. For more information on how to obtain a consult, click here.

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Case history: Jennifer is a 19 year-old female who presented to her primary care physician with excruciating lower back pain after having sustained a fall from 15 feet during a hiking accident. On physical exam, Jennifer was point tender over her upper lumbar spine. Lumbar radiographs were performed, demonstrating a spinal compression fracture of the first lumbar vertebral body. Jennifer was referred for an MRI of the lumbar spine, which also demonstrated the spinal compression fracture.

Reason for consult: The patient and her family were understandably worried about this fracture and what it might mean. They had several questions: How common is this type of fracture? How serious might this be? Are there any specific concerning findings on the MRI? Was anything missed on the initial interpretation?

Imaging review: The lumbar MRI demonstrates a spinal compression fracture of the L1 vertebral body. There is 20% height loss, most marked anteriorly (in the front of the vertebra). The fracture involves the anterior and middle column, with no involvement of the posterior column.

There is no retropulsion (the fracture does not protrude back into the spinal canal). There is no spinal canal stenosis. The conus (the last part of the spinal cord) ends at T12-L1 and is not compressed. There is no compression of nerve roots. No underlying lesion is seen in the vertebral body. The initial reporting of the exam was correct.

The consult: As with all consults at Lightbulb Radiology, Jennifer received an online face-to-face consultation where we could see and talk with each other, and we could go over the imaging study together. See what a consult looks like here.

First off, I was able to reassure the family that this spinal compression fracture was not a catastrophic event. Although all spinal fractures are serious, this is a very common fracture pattern and does not have any specific worrisome features. There is no retropulsion and no compression of neural structures that might complicate her recovery.

Jennifer and her family responded well to this news. Simple reassurance can be the most powerful part of the consult experience. Sometimes patients fail to get a good sense of the importance of imaging findings from their physician (they get worried for no reason or they simply don’t understand what the imaging showed). See when a consult may be useful here. This uncertainty puts them in a poor position to make treatment choices. The peace of mind at knowing the importance of an imaging finding—whether or not it is a scary diagnosis—can be tremendously helpful to the patient.

I was then able to show Jennifer and her family the images and explain all of the features of the fracture. Actually seeing the imaging study helped to solidify the family’s understanding of what had happened to Jennifer’s spine. Seeing the partially collapsed vertebra and comparing it to the adjacent normal vertebra gave the family a picture with which to frame their understanding of her condition.

For Jennifer herself, knowing what the spinal compression fracture actually looks like helped make sense of the pain she was experiencing. This was a fairly straightforward case but it still illustrates the power of a direct consult with a radiologist, even when the second opinion does not differ from the original interpretation. Jennifer has become more educated about her own injury, and therefore can get the most out of the recommendations of her treating physician.

Rourke Stay, MD is a radiologist and the Founder of Lightbulb Radiology.

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