Presentation
Six weeks of ataxia and falls. Hyperreflexic lower limbs. Loss of proprioception in both upper and lower limbs. Right hand weakness.
Patient Data
Multilevel degenerative disc disease with uncovertebral and facet joint arthropathy. There is a C4/5 central disc extrusion, along with buckling and calcification of the ligamentum flavum, resulting in severe central canal stenosis with marked cord compression . Mild foraminal narrowing bilaterally.
Case Discussion
CT myelography is useful in assessing patients with potential cord or nerve compression where MRI is contraindicated (most commonly an incompatible permanent pacemaker). Water soluble low ionic contrast is injected via lumbar puncture (usually image guided). This patient proceeded to an anterior cervical discectomy and fusion (ACDF) to treat the severe central canal stenosis.
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