PMC5991269_01
Preoperative imaging in patient with new-onset autonomic dysreflexia and long history of complete C7 quadriplegia. CT imaging in axial (a), sagittal (b), and coronal (c) views showing sclerosis, joint erosion and effusion, paraspinal osseous fluid collection, T8-9 vertebral body destruction with air spaces, and intervertebral disc destruction at the T8-9 interspace. T2-weighted noncontrast MRIs in sagittal view (d and e) shows debris and disorganized fluid within the disc space of T8-9, significant vertebral body erosion of T8-9, complete loss of intervertebral disc integrity at the T8-9 interspace, inflammation and erosion of posterior elements, and proximal syrinx formation from C4-5 to mid-body T2. formation from C4-5 to mid-body T2
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F1
C5-6; mild lumbar spondylosis; and degenerative changes with anterior osteophytes of multiple thoracic levels with no major deformities, spondylolisthesis, or acute compression fractures. CT showed no evidence of an acute or chronic pathologic process in the brain and marked fluid collection was seen in the T8-T9 interspace with destruction of the intervertebral disc space and degradation of the vertebral bodies [Figure 1].
Postoperative plain thoracic X-ray (lateral view) showing vertebral body cage placement and posterior construct with fixation at T6-T7 and T10-T11
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F2
Magnetic resonance imaging showed a nonenhancing expansive spinal cord lesion that extended from C4-5 to mid-body of T2, which was consistent with syrinx [Figure 2]; its intensity characteristics, which were similar to cerebrospinal fluid (CSF), had worsened compared with an earlier image. The procedure was well tolerated, the postoperative course uncomplicated, and adequate decompression and proper location of all instrumentation confirmed on postoperative imaging [Figure 2].
At 1-year follow-up, imaging of thoracic spine. Plain lateral X-ray (a) and (b) sagittal T2-weighted non-contrast MRI (b) showing stable construct, cord decompression, restoration of lordosis, and syrinx resolution
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F3
At 1-year examination, MRI and upright X-ray films demonstrated a stable construct, good cord decompression, and resolution of the syrinx [Figure 3].