PMC6682322_01
Preoperative CT. (A, B) CT-scan sagittal reconstruction (bone windows). (A, D) CT-scan transverse cut at the C4-5 level. CT revealed disc herniation at C4-5 (arrow) and ossification of the posterior longitudinal ligament.. Note: N/A indicates not available.. Abbreviations: OPLL, ossification of posterior longitudinal ligament; BSS, Brown-Sequard syndrome; HS, Horner syndrome.
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CT revealed C3-7 intervertebral disc herniations and OPLL (Figure 1).
Preoperative MRI. (A) T2-weighted images and b: T1-weighted images. Sagittal image of the cervical spine reveals large disc herniation at C3-C7 and C4-C5 with severe spinal cord compression. A "halo" of CSF isointensity surrounds the herniated disc (arrow). (C, D) Axial T2-weighted image of the cervical spine reveals large, central disc herniation at C4-C5 (arrow) with severe spinal cord compression and surrounding edema.
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MRI showed C3-7 intervertebral disc herniations (most prominent at C3/4, C4/5, and C5/6) and marked compression of the dural sac (Figure 2). A "halo" was seen around the C4/5 level protrusion (Figure 2A).
Intraoperative photograph and sagittal and axial magnetic resonance images obtained 3 months postoperatively. (A) A small breach in the dura mater (white arrow) was seen after the removal of the nucleus pulposus. There was minimal cerebral spinal fluid leakage. T1-weighted (B) and T2 weighted (C, D) MR images reveal satisfactory segmental decompression and no compression of the dural sac (whitarrow).
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After the nucleus pulposus was removed, a small break in the dura mater, with exudation of cerebrospinal fluid (CSF), was apparent (Figure 3A). Imaging showed stable internal fixation, satisfactory decompression of the surgical segment, and no compression of the dural sac (Figure 3B-D).
Preoperative and postoperative follow-up radiographs; (A) lateral radiograph of the cervical spine shows absence of the physiological curvature, with degenerative changes in the cervical vertebrae. (B) Radiograph obtained 3 days after surgery shows partial restoration of the cervical curvature. (C) Radiograph obtained 3 months after surgery shows no displacement of internal fixation. (D) Radiograph obtained 1 year after surgery shows stable internal fixation.
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Figure 4 shows the preoperative and follow-up radiographs.