Bone scintigraphy in acute intraosseous disc herniation

A 57-year-old woman initially presented with the acute onset of low back pain after gardening. Plain film at that time was reported as showing Scheurmann's disease of the lumbar spine. The pain resolved slowly, but recurred acutely after minimal trauma 5 months later. Bone scintigraphy revealed increased uptake in L4 and L5 around the disc space, thought to be suspicious for discitis. Other blood tests revealed a high alkaline phosphatase level with an elevated bone component. The erythrocyte sedimentation rate and leukocyte count were not elevated. Magnetic resonance imaging (MRI) showed an acute disc herniation of the L4/L5 disc into the lower body of L4 with considerable bone marrow edema. Follow-up imaging showed substantial resolution of marrow edema 18 months later. Acute disc herniation has rarely been reported in the scintigraphic literature and should be kept in mind in such circumstances, particularly in older patients.