Clinical Cases

High-grade spinal stenosis in the cervical region


In 1999, this patient took a fall in a staircase and experienced a contusion of the myelin sheath.

The fall resulted in paraplegia with a flaccid paresis of arms and legs. Clinical rehabilitation has lead to an incomplete restitution, spastic tetraparesis prevailing more on the right than on the left side of the body.

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A – B: Sagittal images in a sitting position: neutral and extension

C – D: Coronary Image in sitting position, head neutral 

Findings:

The functional images, upright in a natural weight-bearing state, prove instability at C2-C3.

In a neutral position, a high-grade spinal stenosis can be seen at C2-C3. Due to retrospondylosis, inter-vertebral disk protrusion and a dorsal bone spur, the spinal canal appears extremely narrow (pincer-shaped).

The myelin is compressed and considerably thinned out. In flexion, the disc herniation at C2-C3 is significantly flatter and the dorsal herniation has disappeared. As a result, the spinal canal looks considerably larger and the compression of the myelin appears reduced. In extension, spinal stenosis increases.

Diagnosis:

In a neutral position, the images produced by means of the Upright™ MRI show a high-grade stenosis of the spinal canal at C2-C3 with considerable compression of the myelin. This results partially from the disk herniation and is probably worsened by a fold in the posterior longitudinal ligament and the dorsal protrusion of the ligamentum flavum.

In flexion, a distinct enlargement of the spinal canal is visible, caused predominantly by a flattening of the disk herniation at C2-C3 and the fact that in this position the ligamentum flavum lies flat dorsally.

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