Clinical Cases

Severe functional spinal canal stenosis of the cervical spine

The patient presented here sustained considerable bruising to the head and cervical spine on falling down the stairs in 1999. This resulted in contusion of the myelon and instability between C2 and C3.

Paraplegia with total flaccid paresis of the arms and legs occurred immediately after the fall.

Rehabilitation resulted in incomplete restoration, predominantly to the left as opposed to the right.

Cervical Spine
A: Sagittal T2-weighted image in the neutral position
B: Axial T2-weighted image in the neutral position
Cervical Spine
C: Sagittal T2-weighted with flexion
D: Axial T2-weighted with flexion

The instability in segments C2-C3 was clearly apparent from the functional images in a natural weight-bearing position.

In the sagittal neutral position (Fig. A), there is evidence of a tapering structure in the dorsal region, causing pincer-shaped narrowing of the spinal canal in intervertebral discs C2-C3.

Disc protrusion in C2-C3 levels off considerably in the sagittal flexion position (Fig. C). Even the circumscribed protrusion is no longer evident from the dorsal view. Hence the spinal canal now appears to be considerably wider with less compression of the myelon.

The axial-weighted image in the neutral position (Fig. B) reveals a crescent-shaped structure with signal reduction, which considerably narrows the area near the protruding intervertebral disc on the dorsal side and, on the ventral side, the spinal canal, and compresses the myelon.

This is probably the raised Ligamentum flavum, which appears partially calcified.

The axial image with flexion (Fig. D) clearly highlights the expansion of the spinal canal which is probably mostly due to the levelling off of the protruding discs in segments C2-C3 and the fact that the Ligamentum flavum is now tightened and positioned dorsally.

There is evidence of severe narrowing of the neural foramina in both the neutral and flexion positions on both sides.

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