Presentation
Neck pain.
Patient Data
C6-7 mild anterior subluxation.
Spondylodegenerative changes are noted manifested as diminished heights and hydration signals of the examined discs as well as marginal osteophytes.
Flowing ossification is seen along the anterior longitudinal ligament along the upper cervical vertebrae from CV2 down to CV6, reflecting diffuse idiopathic skeletal hyperostosis (DISH).
C6-7 diffuse posterior pseudo disc bulge, associated with focal central posterior disc protrusion, effacing the ventral subarachnoid space, indenting the ventral cord aspect with mild bilateral foraminal encroachment. This is associated with focal degenerative type canal tightness, at the same level, exaggerating the effect of C6-7 disc.
Faint focal T2 hyperintensity noted in the cord substance opposite C6-7 level, reflecting compression myelopathy.
C5-6 mild diffuse posterior disc bulge, effacing the ventral subarachnoid space, mildly indenting the ventral cord aspect with partial bilateral foraminal encroachment, more on the right.
Diffuse thick continuous anterior osteophytes involving anterior aspect of C2-C6 vertebral bodies.
Ossification of the posterior longitudinal ligament at C3-C6 levels.
C6/7 uncovertebral osteoarthrosis is noted, with subcortical cystic changes and sclerosis. Chronic degenerative changes are noted at the disc with a vaccum effect. Mild degenerative anterior subluxation is noted at the same level.
Case Discussion
Diffuse idiopathic skeletal hyperostosis is characterized by the flowing ossification of the anterior longitudinal ligament. In this case, it is complicated by osteoarthritic changes of C6-7, the disc level below its end, probably due to increased stress of neck movement at this level, resulting in mild degenerative anterior subluxation, chronic disc degenerative changes, coupled with diffuse posterior pseudo disc bulge and associated central posterior disc protrusion; resulting in cord indentation and bilateral foraminal encroachment, resulting in secondary spinal canal stenosis and mild compressive myelopathy.