Clinical Cases

Functional multi-segmental spinal canal stenosis in the region of the cervical spine.


The 44 year-old female patient presented here is intolerant to numerous chemicals. She is complaining of discomfort in both shoulders and a diffuse, bilateral tingling sensation in the upper extremities. No dizziness and headaches were reported.

An MRI scan of the cervical spine was taken to clarify the symptoms.

Standard MRI scan in the supine position

Cervical Spine
A: Sagittale T2-weighted standard supine image

A standard MRI scan in the supine position revealed flat, dorsal protrusions of the intervertebral discs in segments C4/5 and C5/6 with no evidence of spinal canal stenosis or nerve root compression at these levels. Signs of slight compression of the myelon at C5/6.

Upright MRI scan with natural weight-bearing position

Cervical Spine
B: Sagittale T2-weighted image in the neutral seated position

No significant changes in intervertebral disc status in segments C4/5 and C5/6 in the upright neutral seated position compared to a standard MRI scan in the supine position.

Upright MRI functional examination in a natural weight-bearing seated position

The flexion position (Fig. C) revealed only very flat intervertebral disc protrusion in the dorsal region, in segments C4/5 and C5/6. The ventrodorsal diameter of the central sections of the spinal canal at these levels was clearly wider compared to images taken in the upright neutral position (Fig. B).

C: Sagittal T2-weighted, flexed and seated

However, the extension position (Fig. D) highlighted a marked reduction in spinal canal diameter due to extended protrusion of the intervertebral discs essentially in the left mediolateral region with compression of the myelon and additional osseous components.

D: Sagittal T2-weighted, extended and seated

Slight retrolisthesis of C5 and C6 were highlighted in a natural weight-bearing position on the Upright MRI scan. An anterior instability could be ruled out on functional assessment.

The Upright MRI functional examinations with flexion and extension revealed posture- and movement-dependent multi- segment spinal canal stenosis from C4 to C7, predominantly in the left median and paramedian regions, which explains the patient’s symptoms.

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