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23b - Answer: Weakness in the right lower 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: Weakness in the right lower extremity.

TECHNIQUE:

Outside MR images of the cervical spine from February 20, 2017 at family imaging were submitted for second opinion
interpretation.

FINDINGS:

Cervical spine:

Postoperative changes are present with laminectomy defect from C3 through C7. There are posterior element screws present bilaterally. At the C2-3 level there is a central disc herniation with extrusion that indents the thecal sac but does not compress the spinal cord.

Beginning at the C3-4 level the spinal cord caliber is diminished and there is high signal intensity to it more on the left than the right. There is abnormal tissue which is seen spanning the C3-4 level to the upper C6 level which may represent ossification of the posterior longitudinal ligament which compromises the anterior epidural space. There is mild foraminal narrowing at C3-4 and C4-5 and moderate right-sided foraminal narrowing at C5-6.

At the C6-7 level there is left paracentral osteophyte with uncovertebral joint degenerative change and moderate left foraminal narrowing. The C7-T1 level is unremarkable. Pedicle screws are present at the T1 level.

The ossification of the posterior longitudinal ligament is confirmed on the CT scan from October 18, 2016.


IMPRESSION:

Postoperative changes with cervical spine fusion for ossification of the posterior longitudinal ligament. Thoracic ligamentum flavum thickening and degenerative facet joint disease with ligamentum flavum thickening contribute to thoracic spinal stenosis most notably at T5-6 and lumbar spinal stenosis most notably at L3-4. Cord signal abnormality is present centrally at the T5-6 level and in the cervical spine from C2 to C4 5 with cord atrophy.

LESSON 6, TOPIC 9

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022