Presentation
Recent fall with hyperextended neck, complaint of persistent neck pain with persistent upper limbs numbness and weakness.
Patient Data
No fracture with preserved alignment. No prevertebral soft tissue swelling. Multi-levels of osteophytes, ossification of anterior longitudinal ligament, posterior longitudinal ligament (from C2 till C7 levels) and supraspinous ligament/ligamentum nuchae results in significant bony spinal canal stenosis.
Long segment of hyperintensities on both T2WI and STIR sequence from C2 till C6 levels within the central aspect of spinal cord.
High signal intensity on both T2WI and STIR (more conspicuous on STIR sequence) within the interspinous ligaments C2/C3, C3/C4 and C4/C5 levels and minimal amount at prevertebral soft tissue, in keeping with acute inflammatory processes.
Multilevel disc osteophyte complexes from C2/C3 to C6/C7 and the thickened ossification of posterior longitudinal ligament indent onto the anterior thecal sac result in moderate spinal canal stenosis, worst at C4/C5 with AP diameter measuring 0.4cm. No facet joint arthropathy. No ligamentum flavum hypertrophy.
Annotated images on the plain CT cervical spine and MRI cervical spine to show the relevant imaging findings.
Case Discussion
Central cord syndrome is the most common type of incomplete spinal cord injury as the result of traumatic hyperextension cervical injury. This injury is confined to the central portion of the spinal cord, most commonly affecting the cervical spinal cord.
In this case, the central cord syndrome occurs as the result trauma in the setting of degenerative canal stenosis with ossification of posterior longitudinal ligament (OPLL).
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