Traumatic spinal cord injury with underlying congenital cervical stenosis and OPLL
Presentation
Dizziness after coming out from the toilet and fell forwards in prone position at home. Post fall, had pain and numbness over right hand, abdomen and lower limbs and unable to ambulate. Clinically, power and sensory loss from the level of T1 below
Patient Data
Developmentally narrow cervical spine bony canal with segmental ossification of the posterior longitudinal ligament (OPLL) from C2 to C7 levels causing spinal canal stenosis, worse at C5 and C6 level (0.8 cm in AP diameter).
Mild reduction in the vertebral body heights of C5 and C6 vertebra, however, no cortical break seen to suggest acute fracture. The alignment, rest of vertebral body and disc heights are preserved. Atlanto-axial and atlanto-occipital joints are preserved. No facet joint subluxation or dislocation. No prevertebral soft tissue thickening.
Incidental left thyroid nodule.
Overall findings suggestive of congenital cervical stenosis with OPLL. No acute cervical bony injury.
Developmentally small cervical spinal canal with sagittal canal diameter of less than 11mm, suggestive of congenital stenosis1. Segmental OPLL from C2 to C7 levels as seen on CT scan causing further bony spinal canal stenosis.
Multilevel central disc protrusions and thickened posterior longitudinal ligament cause severe spinal canal stenosis, worst at C5/C6 level (6.5 mm in AP diameter) with spinal cord compression. Diffuse central high T2/STIR signal intensity of the spinal cord from C3/C4 to C6/C7 levels. A small focal area of intramedullary low signal intensity was seen on T2W and gradient echo images at C5/C6 level suggestive of hemorrhagic component. The rest of the visualized spinal cord is preserved.
Mild reduction in vertebral body heights of the C5 and C6 vertebra, there is no abnormal high signal intensity within. Alignment, rest of the vertebral body heights are preserved.
Minimal anterior paraspinal fluid collection extending from C2 to C6 level.
IMPRESSION: Congenital spinal canal stenosis, OPLL and multilevel disc herniations, worst at C5/C6 causing traumatic spinal cord injury with hemorrhagic component.
Case Discussion
This patient has congenital cervical canal stenosis compounded by further stenosis due to OPLL (acquired cause). These two factors put him at increased risk of traumatic spinal cord injury despite a history of seemingly trivial trauma.