Cervical disc protrusion with cord compression

Case contributed by Derek Smith


Fall onto face with onset of parasthesia and altered sensation on examination following this of arms, trunk, legs. Normal power and reflexes.

Patient Data

Age: 40 years
Gender: Male

Large central disc protrusion at C5/C6 with compression of the spinal cord and myelopathic signal change from C5 to the inferior C6 level.

Abnormal kyphosis centered on C5/C6.

Edematous signal in the C5 and C6 vertebral bodies, as well as the C7 superior endplate. Possible posterior corner disruption of C7 but otherwise no cortical abnormality or vertebral body fracture. No posterior element abnormality.

No ligament disruption. No abnormal disc signal.

Large anterior degenerate osteophytes at C5/C6 and C6/C7, with posterior disc-osteophyte complex at C6/C7.

No prevertebral abnormality. Normal anticipated vertebral signal voids. Normal included extraspinal tissues.

6m follow up - conservative Rx


Improved appearance of the C5/C6 disc osteophyte complex, with increased AP diameter of the vertebral canal at this level. On axials, CSF is now present all around the spinal cord although the cord remains distorted. A small myelopathic cyst persists in the dorsal cord but most of the other signal change has improved (best contrasted on STIR). Resolving edema in the C5-7 vertebral bodies.

Mild C6 foraminal stenoses.

Case Discussion

These appearances are considered to be a mix of chronic degenerate changes exacerbated by an acute traumatic event leading to presentation to hospital and detection of the myelopathic changes in the cervical spine. The persisting dorsal cystic change would correspond with sensory abnormalities as described.

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