Wladimir von Bechterew was a neurologist and psychiatrist in St. Petersburg around 1900. His psychiatric ideas and models were highly speculative, but his neuroanatomical scientific work is relevant to this day. He was one of the first to comprehensively describe ankylosing spondylitis. One of his colleagues and major rivals in St. Petersburg was Ivan Pavlov, whose experiments we all know. In 1927 the leader of the Soviet Union, a certain Comrade Stalin, sought his medical advice. The 70-year-old Bechterew diagnosed a grave paranoia and did not hesitate to tell the dictator. Bechterew survived the diagnosis by a whole day.
• Diagnosis: After analyzing the malalignment of Mr. Walton's lumbar spine, both Paul and Ajay come to the same conclusion: there is an osseous defect in the pars interarticularis of L4. This is a true spondylolysis with associated spondylolisthesis and is the most likely explanation for the patient's complaints. Could an additional disk herniation have aggravated the situation? Of course. If there are nerve root symptoms and surgery is considered as an option, an additional MRI is indicated and could verify the disk herniation.
The radiograph of the lumbar spine can allow diagnosis of osteochondrosis, malalignment, instability, spondylolysis and ankylosing spondylitis. It should always be the first imaging modality to be used in back pain.
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