PMC4533374_01
A: Axial computed tomography (CT) images demonstrating hypertrophy of the left facet at C7/T1 resulting in marked compression of the dural sac (arrow). B: Sagittal reconstruction of CT images revealing facet hypertrophy at the left C7/T1 level (arrow).
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C7/T1. Computed tomography (CT) disclosed hypertrophic changes in the left C7/T1 facet joint and encroachment on the spinal canal (Fig. 1A). Sagittal reconstruction of CT images showed hypertrophic changes of the left Th1 superior facet (Fig. 1B).
A: Axial T2-weighted magnetic resonance imaging (MRI) of the C6/7 intervertebral space level revealed disc herniation in the left postero-lateral direction (arrow). B: Axial T2-weighted MRI of the C7 vertebral body level demonstrates stretching of the spinal cord by facet hypertrophy (arrow). C: Contrast-enhanced axial T1-weighted MRI of the same level shown in B showed no enhancement. D: Sagittal T2-weighted MRI disclosed compression by a low-signal mass due to cervical disc hernia at the C6/7 level (arrow). Note the bony protrusion behind the C7 vertebral body.
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Axial T2-weighted MRI revealed cervical disc herniation with protrusion at the C6/7 level (Fig. 2A); the dural sac was compressed at the level of the C7 vertebral body by a low-intensity non-enhanced mass (Fig. 2B, C). Sagittal MRI scans showed compression of the spinal cord at the C6/7 level attributable to cervical disc herniation at C6/7 and left facet hypertrophy at the level of the C7 vertebral body with extension above the herniation (Fig. 2D).
A: Intraoperative photograph obtained during anterior decompression and fusion surgery showing a bony structure after C7 corpectomy. The surgeon stood on the left side of the patient. The asterisk marks the facet hypertrophy as seen from the left side. B: Intraoperative photograph demonstrating dural sac decompression after removal of the facet hypertrophy. The arrow marks the level of the left C7 nerve root. C: Postoperative axial CT images confirming enlargement of the spinal canal. Note the residual part of the bony protrusion (arrow).
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On the left in the spinal canal, we noted a bony structure that was not an ossified posterior longitudinal ligament but rather a protrusion from the left facet (Fig. 3A). After adequate decompression of the left C7 nerve root and dural sac, (Fig. 3B) a titanium mesh cage filled with autologous bone chips from the corpectomy was introduced. Postoperative CT confirmed decompression of the spinal cord (Fig. 3C).