Severe spinal canal stenosis

Case contributed by Dr Bruno Di Muzio

Presentation

Severe weakness, unable to walk.

Patient Data

Age: 81
Gender: Male
X-ray

Grade 1 spondylolisthesis of C3 on C4 as well as C4 on C5.

Diffuse degenerative changes from C4 to C7 characterised by facet joint arthropathy.  

At the atlanto-dens articulation there is loss of joint space.

CT

CT Cervical spine

Grade 1 (3 mm) anterolisthesis of C3 on C4 as well as C4 on C5.

C4/5: Posterior disc osteophyte complex results in moderate central canal narrowing and severe bilateral foraminal stenosis.

C5/6: Posterior disc osteophyte right complex results in severe central canal stenosis and presumed flattening of the cord. Severe bilateral foraminal stenosis.

C6/7: Posterior disc osteophyte complex results in moderate central canal narrowing and bilateral (left > right) moderate/severe foraminal stenosis.

At the atlanto-dens articulation there is loss of joint space and possible ankylosis Throughout the remainder of the cervical spine there is mild central canal and foraminal narrowing, as well as facet joint arthropathy at multiple levels. Soft tissues of the neck are unremarkable and the lung apices are clear.

Conclusion:

Severe central canal stenosis maximal at C5/6 due to posterior disc osteophyte complex in the context of multilevel degenerative change is outlined above.

MRI

MRI Spine

C2/3: Small central disc protrusion and mild hypertrophy of the ligamentum flavum result in mild narrowing of the vertebral canal. Capacious intervertebral foramina.

C3/4: 2 mm anterolisthesis.

Moderate central disc protrusion indents the spinal cord anteriorly, with normal cord signal maintained. Mild stenosis of the right and moderate stenosis of the left intervertebral foramina.

C4/5: Posterior disc/osteophyte complex mildly narrows the vertebral canal, severely narrows the right intervertebral foramen and moderately narrows the left intervertebral foramen. Mild increased T2 signal in the cord.

C5/6: Posterior disc/osteophyte complex with central protrusion severely narrows the vertebral canal and flattens the cord, with minor T2 cord signal change. Severe narrowing of the intervertebral foramina on both sides.

C6/7: Posterior disc/osteophyte complex mildly narrows the vertebral canal. There is severe stenosis of bilateral neural foramina.

C7/T1: Disc protrusion on a background posterior disc/ossified complex and ligamentum flavum hypertrophy severely narrows the vertebral canal and result in compression of the spinal cord, with mild increased T2 signal. There is severe stenosis of the internal foramina bilaterally.

Thoracic spine:

Normal thoracic spine alignment. Disc bulge at T9/10 with ligamentum flavum hypertrophy results in moderate narrowing of the vertebral canal and subtle indentation on the cord. The neural canal is capacious at other levels. No significant stenosis of intervertebral foramina.

Lumbar spine:

There are 5 lumbar-type vertebral bodies. The conus terminates at the L1/2 level. Congenitally short pedicles result in baseline mild narrowing of the vertebral canal at all levels. Mildly prominent epidural fat also contributes to narrowing of the vertebral canal, particularly at the lower lumbar levels.

T12/L1: Capacious vertebral canal and intervertebral foramina.

L1/2: Disc bulge does not significantly further narrow the vertebral canal. The intervertebral foramina are capacious.

L2/3: Disc bulge and ligamentum flavum hypertrophy contribute to severe narrowing of the vertebral canal and effacement of the lateral recesses. Elongation of nerve roots above this level is futher evidence of mechanically significant impingement. Moderate narrowing of the right and mild narrowing of the left intervertebral foramina.

L3/4: Disc bulge and ligamentum flavum hypertrophy contribute to severe narrowing of the vertebral canal and effacement of the lateral recesses. Mild narrowing of the right intervertebral foramen. Left intervertebral foramen is relatively capacious.

L4/5: Disc bulge and ligamentum flavum hypertrophy contribute to severe narrowing of the vertebral canal and effacement of the lateral recesses. Intervertebral foramina are relatively capacious.

L5/S1: Disc bulge with central protrusion without significant further stenosis of the vertebral canal. Intervertebral foramina are capacious.

Conclusion:

Severe cervical spine degenerative disease with severe narrowing of the vertebral canal at C5/6 and C7/T1. Increased T2 signal of the cord at C4/5, C5/6 and especially C7/T1. Multilevel foraminal stenosis as described.

Multilevel severe lumbar spine stenosis most marked at L2/3, L3/4 and L4/5.

Case Discussion

Degenerative changes is one of the causes that lead to spinal canal stenosis

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Case information

rID: 38265
Case created: 13th Jul 2015
Last edited: 15th May 2016
Tag: rmh
Inclusion in quiz mode: Included

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