Clinical Cases

Position-dependent intervertebral disc prolapse in the region of the cervical spine

The 44 year-old female patient presented here has been complaining, for approximately one year, of cervical spine discomfort radiating to the head and face.

The discomfort was mainly experienced in the upright position and was particularly severe on leaning backwards. Nerve root compression in segment C7 was suspected following clinical examination.

A conventional MRI scan in the supine position revealed protrusion (approximately 3 mm) in cervical vertebrae 5/6 with no essential narrowing of the spinal canal and no adverse effects on nerve roots.

Given the persistent discomfort, an Upright MRI scan was performed with the cervical spine in a natural weight-bearing position together with additional functional images on flexion and extension.

Cervical Spine
A: Sagittal T2-weighted on flexion
B: Sagittal T2-weighted in a neutral position
C: Sagittal T2-weighted on extension
D: Axial T2-weighted in the neutral position

The  finding:

The Upright MRI scan was performed seated, upright and in a natural weight-bearing position.

Images in the neutral position reveal intervertebral disc prolapse extending from the median / mediolateral to the intraforaminal region on the left, with compression of the myelon and compression and displacement of nerve root C7 in the left, interspinal region.

The intervertebral disc protrudes the dorsal vertebra by 5 mm. The ventrodorsal diameter of the central sections of the spinal canal are narrowed to 6 mm as a result. The functional images con rmed a reduction in the extent of the intervertebral disc prolapse on flexion and an increase in the width of the central sections of the spinal canal to 8 mm.

The functional images on extension revealed a marked increase in intervertebral disc  ndings with primarily craniocaudal expansion and marked protrusion of the posterior longitudinal ligament. The Ligamenta flava was also prominent, resulting overall in the central narrowing of the spinal canal to 4.5 mm.

The cause of the symptoms could be accurately diagnosed through functional examination via Upright MRI in the upright, natural weight-bearing position. Nerve root compression suspected on the basis of clinical  ndings could be con rmed. Position-dependent compression of the myelon was also detected.

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