Clinical Cases

Position related herniated cervical disc


For a year this 44-year-old female patient has been complaining about pain in the cervical spine region, radiating into head and face.

The pain occurs mainly when standing and is especially severe in extension. After clinical examinations, a compression of the nerve root was suspected at segment C7.

The patient underwent a conventional MRI examination in the supine position revealing a protrusion (approximately 3mm) at C5-C6 without significant narrowing of the spinal canal and without apparent damage to the nerve root.

Due to persistent pain, the patient obtained an upright MRI of the cervical spine in a natural weight-bearing state and additional functional images in flexion and extension.

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A – B: Sagittal images in sitting position: flexion and extension

C: Sagittal image in sitting position: neutral

D: Axial image in sitting position: neutral

Findings:

The Upright-MRI examinations were performed in a sitting position, upright and in a natural weight-bearing state. The images in the neutral position display a median /medio-lateral disc herniation with compression of the myelin within the left intra-foraminary radiation as well as a compression and displacement of the left interspinal C7 nerve root. The intervertebral disk protrudes beyond the vertebral body by 5 mm. For this reason, the ventro-dorsal diameter of the central parts of the spinal canal is reduced to 6mm.

In flexion, the functional images display a decrease in size of the herniated disc and an increase in diameter of the central parts of the spinal canal to 8 mm.

In extension, the functional images display a significant increase in size of the herniated disc, especially in cranio-caudal extension, with a clear protrusion of the posterior longitudinal ligament and the prominence of flaval ligaments. For this reason, the central part of the spinal canal is decreased in diameter to 4.5 mm.

After a functional examination in the Upright-MRI, in a natural weight-bearing state, the cause for the pain could be clearly identified. The already suspected compression of the nerve root could be confirmed and a position-related compression of the myelin was proven.

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