Cervical canal stenosis - OPLL and osteophytes

Case contributed by Dr Bruno Di Muzio

Presentation

Trauma.

Patient Data

Age: 60
CT

CT Cervical spine

No acute cervical spine injury. Non-union of the posterior arch on the right of C1 which is long-standing, either an old fracture or congenital abnormality. Large posterior disc osteophyte complex at C5-6 causes cord compression and spinal canal stenosis. Given the degree of cord compression, neurological assessment and possible elective outpatient MRI may be indicated to further assess.

MRI

MRI Cervical spine

The vertebral bodies have normal height and alignment. Nonunion of the C1 posterior arch on the right (more conspicuous on CT) is consistent with an anatomical variant. There is degenerative ankylosis of C4 and C5 vertebral bodies associated with MODIC 2 signal changes of their interposed endplates. No bone marrow edema, facet joint effusion or abnormal disc signal. Anterior to the C4-C6 vertebral body as well as a thin layer of prevertebral high signal, however, this is not associated with evidence of anterior longitudinal ligament or disc disruption. The posterior longitudinal ligament and ligamentum flavum appear intact. No posterior soft tissue bruising or hematoma. No epidural abscess. Bulky osteophytes/ossification of the posterior longitudinal ligament from C4 to C6/7 is eccentric to the right. This causes severe canal stenosis and cord compression posterior to C5 and C5/6; associated cord edema extends between C4/5 and C6/7. Disc osteophyte complex at C4/5 impinges upon the passing right ventral nerve root and causes moderate right and mild left foraminal stenosis. At C5-6 the eccentricOPLL/osteophytosis impinges the pre-foraminal right C6 nerve root and left uncovertebral osteophytes to cause moderate left foraminal narrowing. At C6-7, there is a mild indentation of the thecal sac by right paracentral protrusion without cord contact or foraminal stenosis. 

Case Discussion

A case illustrating localized ossification of the posterior longitudinal ligament and bulky right paracentral osteophytosis causing severe canal stenosis centered at the level of C5, resulting in cord compression and compressive myelopathy

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Case information

rID: 47329
Published: 16th Jul 2017
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Excluded

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