PMC6180874_01
Sagittal CT reformat demonstrating typical features of ankylosing spondylitis, with extensive bridging thoracic syndesmophytes and diffuse ankylosis of the posterior elements. There is coexisting Paget's disease, with cortical thickening, sclerosis and vertebral squaring. This produces significant kyphotic deformity and narrowing of the central canal.
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However, in addition, there was contiguous spread of the pagetic changes across the diffusely ankylosed thoracic segments (Figure 1).
Pagetic expansion of the T10 vertebral body with extension across the fused costovertebral joints. Bony expansion results in marked reduction in the calibre of the vertebral canal.
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The combination of these pathologies produced a marked kyphotic deformity, with extensive bony expansion of the pagetic thoracic spine that resulted in significant central canal stenosis (Figure 2).
T
2 weighted sagittal MRI of the thoracic spine demonstrating severe central canal stenosis with cord compression and extensive myelopathic change.
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T2 hyperintensity extending from the cervicothoracic junction to T11 (Figure 3). There was sparing of the lumbar segments, with a normal appearance of the distal cord and conus (Figure 4).
T
2 weighted sagittal MRI of the thoracolumbar spine demonstrating normal appearances of the lumbar segments with a capacious lumbar central canal.
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T2 hyperintensity extending from the cervicothoracic junction to T11 (Figure 3). There was sparing of the lumbar segments, with a normal appearance of the distal cord and conus (Figure 4).