Failure of magnetic resonance imaging to reveal the cause of a progressive cervical myelopathy related to postoperative spinal deformity: a case report.
Imaging studies have achieved a high degree of diagnostic accuracy for many disorders of the spinal cord but have significant limitations. We report on the case of a 49-yr-old man who developed neck pain and arm numbness. He was found to have extensive cervical spondylosis, with spinal cord impingement at C3-4 and cervical radiculopathy. He underwent a C3-7 laminectomy, with transient improvement in his symptoms. During the ensuing year, he developed increased weakness of the upper limbs, evidence of cervical myelopathy, and a severely flexed posture of the cervical spine. Magnetic resonance imaging (MRI) revealed cervical spinal cord atrophy but no evidence of extrinsic spinal cord compression. Cervical flexion and extension films revealed reversal of the normal cervical lordosis without segmental instability. Despite the absence of confirmatory radiologic studies, the patient was felt to have clinical evidence of intermittent compression of his cervical spinal cord attributable to excessive cervical kyphosis, was provided with a cervical collar, and subsequently underwent surgical stabilization. His cervical myelopathy showed marked improvement with these treatments. We conclude that intermittent compression of the spinal cord, occurring in the erect position, was not apparent on the MRI films obtained in the supine position. Flexion and extension films, obtained in the upright position, documented his abnormal cervical anatomy but did not reveal substantial segmental instability. Spinal deformity without segmental instability may cause cervical myelopathy after multilevel cervical laminectomies without evidence of extrinsic compression on MRI.
Stein
J
J
Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114, USA.
D001915:Braces; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000628:therapy; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology; D013128:Spinal Osteophytosis / Q000150:complications / Q000175:diagnosis*