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9b - Answer: A patient with neck pain extending into the left upper extremity

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

Learn more about this case by reading the case report below. Additional instruction is provided in the Case Summary section of the course.

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Case Report

HISTORY: Neck pain extending into the left upper extremity. Worse the past 4 days, 10/10 in severity.

FINDINGS:

MRI REPORT:

MRI of the cervical spine.  The examination is performed to evaluate a patient's neck pain extending into the left upper extremity with suspicion of a central canal obstruction.

Axial and sagittal T1 and T2 weighted images are available for reading.
Axial and sagittal T1-weighted images are available after the administration of intravenous contrast material.

Normal brainstem-cervical cord junction.  Normal cisterna magna with no tonsillar ectopia.  Normal clivus with a normal craniocervical junction.
Normal anterior atlantoaxial articulation. There is a prominent reversal of the cervical lordosis at the C6-C7 vertebral body level. Prominent ventral osteophytes are noted C4 through C7 there is a prominent loss in height of the C6 vertebral body.

At C2-C3, C3-C4, C4-C5 and C5-C6 the central canal is anatomic and unremarkable. There is very mild narrowing involving the left lateral neural foramen at the C5-C6 intravertebral level.

At C6-C7 there is a left laterally bulging disc with moderate narrowing of the left lateral neural foramen. A central canal appears to be anatomic.

A prominent left ventral lateral mixed intensity lesion with superior migration is noted at the C7-T1 intravertebral level surrounded by a hyperintense component. There is severe compression of the left ventral lateral aspect of the cervical cord with moderate narrowing of the central canal and severe narrowing of the left lateral neural foramen at
this level.

After the administration of intravenous contrast material no untoward enhancement is seen throughout the bony architecture or the cervical central canal.

IMPRESSION:

Very prominent left ventral lateral mixed intensity lesions superiorly migrating at the C7-T1 level markedly compressing the left ventral lateral aspect of the cervical cord with moderate central canal stenosis and severe narrowing of the left lateral neural foramen. The lesions is most likely of osteochondral origin and a CT scan is recommended for confirmation. Favor osteochondroma.

 CT REPORT: 

CT cervical spine without contrast.  
 
History: Neck pain extending into the left upper extremity.  
 
Technique:  
Axial images through the cervical spine from skull base to thoracic inlet  
without intravenous contrast. Coronal and sagittal reconstructions.  
 
Findings:  
Comparison is made to MRI cervical spine from earlier the same date.  
 
There is reversal of the usual cervical lordosis centered at the C5-C6  level. Vertebral body heights are preserved. There are no acute fractures  or subluxations. There is slight loss of disc height at C5-C6 and C6-C7  levels.  
 
Craniocervical junction is unremarkable.  
 
At C2-C3, there is no significant canal or foraminal narrowing.  
 
At C3-C4, there is no significant canal or foraminal narrowing.  
 
At C4-C5, there is a small left central disc protrusion which focally  flattens the left ventral aspect of the cord. Dorsal CSF spaces  
maintained. Neural foramina are patent.  
 
At C5-C6, there is bilateral uncovertebral hypertrophy and right  greater than left facet hypertrophy. There is mild bilateral foraminal  
narrowing. The canal is patent.  
 
At C6-C7, there is bilateral uncovertebral hypertrophy. This results in  moderate to severe left and mild right neural foraminal narrowing. The  canal is patent.  
 
At C7-T1, there is a large focus of ossification extending medially from  the superior articulating facet of T1 on the left into the spinal canal  occupying approximately 50% of the spinal canal. This was shown to  displace the cord towards the right posterolaterally and compress it on  the MRI from the same date. There is severe canal narrowing as a  consequence. The superior aspect of the neural foramen is widely patent  on the left, but inferiorly, it is severely narrowed. The right neural  foramen is patent.  
 
At T1-T2, no canal or foraminal narrowing.  
 
IMPRESSION:  

Bulky focus of ossification extending medially off of the left superior  articulating facet of T1 into the spinal canal contributes to severe  
canal compromise as indicated on MRI from the same date. Focus of  ossification contributes to severe narrowing of the inferior aspect of  the C7-T1 neural foramen on the left. Favor osteochondral neoplastic lesion over reactive/degenerative lesion. 

LESSON 3, TOPIC 12

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022