PMC6743699_01
Lateral flexion radiograph (a) shows anterolisthesis of C6 on C7, (b) elongation of C6 spinal process is also seen.
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F1
Furthermore, the spinous process of the C6 vertebra was abnormally long and narrow [Figure 1a and b].
(a) The axial computed tomography (CT) scan on bone window settings reveals defect at the joints vertebral body with well-defined border, (b) sagittal reconstruction CT shows slippage of C6 on C7 and abnormally narrow and elongated spinal process of C6 vertebra are demonstrated, (c) paramedian slices show intrusion of spinolaminar junction into the spinal canal at C6 level, (d) in a more lateral sagittal slices, wide foramen which is combination of two foramina are demonstrated.
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F2
The axial computerized tomography (CT) showed a linear defect at the C6 pedicle-laminar junction bilaterally with sclerosis, Grade I spondylolisthesis, and an abnormally long C6 spinal process [Figure 2a and b]. Other CT findings included intrusion of spinolaminar junction into the spinal canal with enlargement of C5-C6 neural foramina [Figure 2c and d].
(a) T1-weighted sagittal view shows an isointense wrap around the theca which is probably fibrous. (b) T2-weighted sagittal magnetic resonance imaging (MRI) demonstrates myelomalacia at C6 level. (c) A more lateral T2-weighted sagittal MRI a block at C6 level is seen. (d) MR myelogram shows complete block between C6 and C7 levels.
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F3
T1 isointense dorsolateral fibrous mass [Figure 3a and b]. The T2 sagittal images also showed an increased central C6 level cord signal [Figure 3c and d].
Intraoperative photograph showing the dura and pedicle screws on C5 and C7 level.
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F4
The patient first underwent a posterior decompression (C6 posterior arch) with C5-C7 pedicle screw fusion [Figure 4].
Postoperative cervical X-ray. (a) Lateral cervical radiograph showing C5 and C7 pedicle screws in appropriate place and C6-C7 interbody fusion, (b) cervical anteroposterior radiograph of the same patient.
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F5
PEEK cage filled with demineralized allograft chips [Figure 5]. Postoperatively, the patient gradually improved within 4 months and continued to do well 2 years later [Figure 5].