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16b - Answer: Neck pain after trauma

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

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Case Report

HISTORY: Neck pain after trauma.

COMPARISON: CT cervical spine on 1/16/2022.

TECHNIQUE/PROTOCOL: Multiplanar multisequence noncontrast cervical spine HNP protocol MR performed.  

FINDINGS:
Vertebral bodies are normal in signal intensity and alignment.
Mild decreased vertebral body height at C4, C5, C6 and C7 likely degenerative in nature.
Multilevel desiccated discs are noted with mild disc space narrowing at C5-C6.

Focal discontinuities noted in the tectorial membrane (series 2 image 10). Suggestion for apical ligament tear. Focal area of T2 hyperintensity is noted in the right lateral attachment of the transverse ligament (series 4 image 10) with no complete discontinuity. Edema is noted in the interspinous ligaments in the posterior cervical spine more prominent at C1-C2. Segmental edema and thinning is noted in the ligamentum flavum at C5 level with no definite discontinued. The posterior
longitudinal ligament and posterior atlantooccipital membrane are intact. Mild edema in the prevertebral soft tissue.

Spinal cord is normal in size and signal. There is no extradural collection.

C1-C2: No spinal canal or foraminal stenosis.
C2-C3: No spinal canal or foraminal stenosis. Tiny herniation at C2-3.
C3-C4: Posterior disc herniation with moderate to severe narrowing of the spinal canal causing deformity of the spinal cord at this level. Bilateral neural foramina are patent.
C4-C5: Posterior osteophyte formation with moderate narrowing of the spinal canal. Mild bilateral narrowing of the neural foramina due to facet and uncovertebral joint hypertrophy.
C5-C6: Posterior osteophyte formation with moderate narrowing of the spinal canal. Bilateral mild neural foraminal stenosis due to facet and uncovertebral joint hypertrophy.
C6-C7: No spinal canal or foraminal stenosis.
C7-T1: No spinal canal or foraminal stenosis.

Neck Soft Tissues: Unremarkable.

IMPRESSIONS:

  1. Focal defect in the tectorial membrane consistent with tear with suggestion for apical ligament tear. Mild prevertebral soft tissue swelling. Intact posterior longitudinal ligament.
  2. Focal area of T2 hyperintensity is noted in the right lateral attachment of the transverse ligament with no complete discontinuity.
  3. Multilevel interspinous ligament injury more advanced at C1-C2. Segmental edema and thinning in the ligamentum flavum at C5 level with no definite discontinuity.
  4. Moderate to severe C3-C4 central canal stenosis secondary to a disc herniation compressing the spinal cord and moderate C4-C5 and C5-C6 with spinal canal stenosis.
LESSON 5, TOPIC 3

Case Challenge: Spine MRI Cases

Case Challenge

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Content reviewed: May 12, 2022

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