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  16b (Spine) - Answer: 55-year-old male presents with history of quadriplegia

HISTORY: 

This 55-year-old male presents with history of quadriplegia. Patient noticing within the last six months the absence of muscle spasms for lower lumbar and lower extremities. No recent injury. No history of surgery for lumbar or thoracic. History of fusion for C4-C7.


(QUIZ ANSWER) PRIMARY FINDING: 

Cystic degenerative myelomalacia behind C6-7 and C7-T1


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Straightening of the cervical lordosis. 

Arthropathic pseudotumor of the dens. 

Prior anterior cervical decompression and fixation C6-7 and C7-T1. Prevertebral soft tissues are unremarkable. 

C2-3: No compressive discopathy. No central canal stenosis. No foraminal stenosis. 

C3-4: Disc desiccation. Bilobed disc protrusion abuts the thecal sac and the exiting C4 nerve root sheaths. Borderline mild central canal stenosis. Moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C4 root effacement. 

C4-5: Decreased disc height and desiccation. Anterior spondylosis. Retrolisthesis. Broad mixed spondylotic disc protrusion eccentric to the right effaces the right hemicord and the exiting C5 nerve root sheaths right greater than left. Mild central canal stenosis. Moderate bilateral foraminal stenosis secondary to facet and Luschka joint hypertrophy with C5 root effacement. 

C5-6: Decreased disc height and desiccation. Retrolisthesis. Broad mixed spondylotic disc protrusion eccentric to the right effaces the thecal sac. Moderate right and mild to moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C6 root effacement right greater than left. Dilatation of the central canal consistent with syrinx formation. 

C6-7 and C7-T1: Prior anterior cervical decompression and fixation with bony bridging. No acute disc herniations. Cystic myelomalacia behind C6-7 and C7-T1 most likely related to patient's prior cord injury. Marked atrophy of the distal cord below these levels. 

 

CONCLUSION

1. C6-7 and C7-T1 prior anterior cervical decompression and fixation with bony bridging. Spinal cord transection with marked cystic degenerative myelomalacia behind C6-7 and C7-T1 is consistent with the patient's history of quadriplegia. Marked atrophy of the distal cord below these levels. 

2. C4-5 Broad mixed spondylotic disc protrusion eccentric to the right effaces the right hemicord and the exiting C5 nerve root sheaths right greater than left. Moderate bilateral foraminal stenosis secondary to facet and Luschka joint hypertrophy with C5 root effacement. 

3. C5-6 Moderate right and mild to moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C6 root effacement right greater than left. Dilatation of the central canal consistent with syrinx formation. 

4. C3-4 Bilobed disc protrusion abuts the thecal sac and the exiting C4 nerve root sheaths. Moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C4 root effacement.


Discussion

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430577 1572451 10999606 16b (Spine) - Answer: 55-year-old male presents with history of quadriplegia /courses/430577/lectures/10999606 true native_comments
430577 1572451 10999606 16b (Spine) - Answer: 55-year-old male presents with history of quadriplegia /courses/430577/lectures/10999606 true text

HISTORY: 

This 55-year-old male presents with history of quadriplegia. Patient noticing within the last six months the absence of muscle spasms for lower lumbar and lower extremities. No recent injury. No history of surgery for lumbar or thoracic. History of fusion for C4-C7.


(QUIZ ANSWER) PRIMARY FINDING: 

Cystic degenerative myelomalacia behind C6-7 and C7-T1


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Straightening of the cervical lordosis. 

Arthropathic pseudotumor of the dens. 

Prior anterior cervical decompression and fixation C6-7 and C7-T1. Prevertebral soft tissues are unremarkable. 

C2-3: No compressive discopathy. No central canal stenosis. No foraminal stenosis. 

C3-4: Disc desiccation. Bilobed disc protrusion abuts the thecal sac and the exiting C4 nerve root sheaths. Borderline mild central canal stenosis. Moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C4 root effacement. 

C4-5: Decreased disc height and desiccation. Anterior spondylosis. Retrolisthesis. Broad mixed spondylotic disc protrusion eccentric to the right effaces the right hemicord and the exiting C5 nerve root sheaths right greater than left. Mild central canal stenosis. Moderate bilateral foraminal stenosis secondary to facet and Luschka joint hypertrophy with C5 root effacement. 

C5-6: Decreased disc height and desiccation. Retrolisthesis. Broad mixed spondylotic disc protrusion eccentric to the right effaces the thecal sac. Moderate right and mild to moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C6 root effacement right greater than left. Dilatation of the central canal consistent with syrinx formation. 

C6-7 and C7-T1: Prior anterior cervical decompression and fixation with bony bridging. No acute disc herniations. Cystic myelomalacia behind C6-7 and C7-T1 most likely related to patient's prior cord injury. Marked atrophy of the distal cord below these levels. 

 

CONCLUSION

1. C6-7 and C7-T1 prior anterior cervical decompression and fixation with bony bridging. Spinal cord transection with marked cystic degenerative myelomalacia behind C6-7 and C7-T1 is consistent with the patient's history of quadriplegia. Marked atrophy of the distal cord below these levels. 

2. C4-5 Broad mixed spondylotic disc protrusion eccentric to the right effaces the right hemicord and the exiting C5 nerve root sheaths right greater than left. Moderate bilateral foraminal stenosis secondary to facet and Luschka joint hypertrophy with C5 root effacement. 

3. C5-6 Moderate right and mild to moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C6 root effacement right greater than left. Dilatation of the central canal consistent with syrinx formation. 

4. C3-4 Bilobed disc protrusion abuts the thecal sac and the exiting C4 nerve root sheaths. Moderate left foraminal stenosis secondary to facet and Luschka joint hypertrophy with C4 root effacement.