Spinal canal decompression

Case contributed by Dr Bruno Di Muzio

Presentation

Numbness and weakness.

Patient Data

Age: 59
Gender: Male
CT

CT Cervical spine

Calcification dorsal to the vertebral bodies of C2 to C7 in a distribution suggestive of ossification of the posterior longitudinal ligament. Large central disc protrusion at C2/3, C3/4, C4/5 results in severe canal stenosis, particularly at C4/5. Severe neural exit foraminal stenosis at C3/4 and C4/5 and C5/6 bilaterally.

Alignment is normal. No suspicious bony lesion.

 

MRI

MRI Cervical spine

Multilevel degenerative disc disease in the cervical spine.

Ossification of the posterior longitudinal ligament between C3 and C5 (better appreciated on recent CT scan) .

There is marked abnormal T2 hyperintensity in the cervical cord at the levels of spinal canal stenosis: C3/4 to C6/7. Given the extent of mass-effect on the cord, degree of parenchymal volume loss cannot be assessed.

Normal alignment.

C2/3: Minor uncovertebral osteophytes cause mild bilateral foraminal narrowing. No spinal canal stenosis.

C3/4: Disc osteophyte complex in combination with central disc protrusion and ossification of the posterior longitudinal ligament causes anterior indentation and flattening of the cervical cord. Some residual CSF surrounds the lateral aspects of the cord and the thecal sac. Uncovertebral osteophytes cause moderate right foraminal narrowing. Foraminal component of disc complex with uncovertebral osteophyte causes severe left foraminal stenosis.

C4/5: Disc osteophyte complex in combination with central disc protrusion and ossification of the posterior longitudinal ligament causes high grade spinal canal stenosis with anterior indentation, posterior displacement, and flattening of the cervical cord, and complete effacement of CSF in the thecal sac. Uncovertebral osteophytes cause severe bilateral foraminal stenosis.

C5/6: Disc osteophyte complex in combination with ossification of the posterior longitudinal ligament results in high-grade stenosis of the spinal canal. There is anterior indentation and flattening of the cervical cord. CSF is almost completely effaced from the thecal sac - a thin rim of CSF surrounding the cord remains. Uncovertebral osteophytes cause severe left and moderate right foraminal narrowing.

C6/7: Disc osteophyte complex in combination with central disc protrusion and ossification of the posterior longitudinal ligament cause anterior indentation and flattening of the cord. Foraminal components of the disc complex causing bilateral foraminal stenosis: Severe on the left and moderate on the right.

C7/T1 to T2/3: No significant spinal canal or foraminal stenosis.

Allowing for limitations of comparison with scanned cut film, extent of abnormality is not significantly changed compared to the previous MRI.

Conclusion:

Multilevel degenerative disc disease and ossification of the posterior longitudinal ligament result in severe spinal canal stenosis between C3-4 and C6-7 intervertebral disc levels with significant multilevel compressive myelopathy.

Multilevel foraminal stenosis between C3-4 and C6-7.

CT

CT Cervical spine (after decompression surgery)

Total laminectomies at C3-6 and partial laminectomy of C7 and posterior fixation are noted, with overlying soft tissue oedema and surgical emphysema. A surgical drain is in situ.

No acute haemorrhage or large haematoma identified. There is satisfactory positioning of the lateral mass screws with no encroachment on the transverse foramina or spinal canal. Alignment of the cervical spine are stable when compared to the previous CT. Prevertebral soft tissues are unremarkable.

Conclusion: Expected postsurgical appearance.

Case Discussion

This case illustrates a severe spinal canal stenosis due degenerative changes that were managed with a posterior cervical decompression surgery. It is possible to compare the difference between the pre and postoperative images in which the spinal cord recovers its normal shape with normal CSF around it. 

 

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Case information

rID: 38465
Case created: 21st Jul 2015
Last edited: 18th Dec 2015
System: Spine
Tag: rmh
Inclusion in quiz mode: Included

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