PMC9479579_01
Representative axial MR GRE sequences from 5 years after surgery (a) and 13 years after surgery (b) shows low intensity signal in the superior cerebellum, indicative of hemosiderin deposition compatible with superficial siderosis. The superficial siderosis is expanding in area from 5 years to 13 years after initial anterior corpectomy and fusion.
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F1
Prior imaging at an outside medical center did reveal evidence of mild superficial siderosis 5 years postoperatively [Figure 1], with worsening of the superficial siderosis seen approximately 13 years after the initial surgery (present day).
(a) Representative axial (left) and sagittal (right) T2-weighted fast spin echo images from 13 years after surgery demonstrating a ventral dural defect (dotted-line arrow) at approximately level C2 and CSF extending from the corpectomy site around the titanium mesh cage (solid-line arrow). (b) Additional axial (left) and sagittal (right) slices demonstrating a fluid collection (solid-line arrows) in the right anterolateral soft tissues of the neck extending from corpectomy site at approximately level C4.
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F2
The cervical spine imaging shows significant arachnoiditis at the level of the surgery with adherence of the dura to the surgical corpectomy site with marked distortion of the spinal cord [Figure 2]. The same MR shows a fluid collection anterolateral to the right of the surgical site in the soft tissue of the neck, originally diagnosed as a thyroid nodule on an outside hospital report [Figure 2].
Coronal (upper left) and sagittal (lower left) scout images of the intact anterior corpectomy with titanium mesh cage, anterior plate and screw construct from C2-C4, and posterior laminectomy and fusion with transpedicular screws and interconnecting rods from C2-C4. Axial (upper middle) and sagittal (upper right) post-injection CT myelogram images demonstrating a ventral dural defect (dotted-line arrow) at level C2 with borderline spinal cord herniation and CSF throughout the corpectomy site and within the titanium mesh cage. Axial (lower middle) and sagittal (lower right) postinjection CT myelogram images showing a fluid collection in the right anterolateral soft tissues of the neck extending from the corpectomy site (solid-line arrows) at level C4.
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F3
During evaluation at our medical center, the patient underwent a total spine CT myelogram due to concern for a CSF leak which may be contributing to the progressive SSCNS findings [Figure 3]. At the C3 level, there was a large ventral dural defect with extrathecal contrast completely opacifying the corpectomy surgical site [Figure 3]. At the C2-C3 level, the cord was anteriorly displaced and markedly deformed, appearing inseparable from the OPLL as well as tethered to the partially intact ventral dura at the mid C3 level, suspicious for a dural defect with borderline SCH [Figure 3]. In the prevertebral soft tissues, at the right anterior C4 level, there was a tract of extrathecal contrast extending into the right neck from C4 through C5-C6 levels, located along the right lateral aspect of the thyroid cartilage [Figure 3].