PMC7265399_01
(a) Sagittal T2-weighted FSE magnetic resonance imaging of the cervical spine in neutral position. Segmental intramedullary swelling with high signal intensity at C5 to C7 level and loss of cervical lordosis. (b,c) Neutral position axial T2-weighted GRE and axial DWI sequence at C5-C6 disc level showing segmental spinal cord hyperintensity with some foci of restricted diffusion (arrow). A median-paramedian disc herniation at the same level was also evident. (d) Sagittal contrast-enhanced T1-weighted FSE acquisition on neck flexion showing a partial enhancement of the spinal cord lesion at C5-C6 level (arrow).
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F1
A 1.5 Tesla cervical magnetic resonance imaging (MRI) showing diffuse lower cervical spinal cord swelling (C4-C7) most severe at C5-C6 with mild spondylosis and a high intrinsic T2-weighted cord signal (e.g. with punctate foci of restricted diffusion) [Figures 1a-d and 2a].
(a) Sagittal T2-weighted FSE image in neutral position with evidence of posterior detachment of dural sac (arrow). (b) Flexion sagittal T2-weighted FSE images confirming anterior displacement of the posterior dura from C4 to C7 levels with spinal cord flattening and prominence of the posterior epidural space (arrow). (c) Sagittal contrast-enhanced T1-weighted FSE in flexion position with evidence of enhancement of the enlarged posterior epidural space (arrow).
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F2
A 1.5 Tesla cervical magnetic resonance imaging (MRI) showing diffuse lower cervical spinal cord swelling (C4-C7) most severe at C5-C6 with mild spondylosis and a high intrinsic T2-weighted cord signal (e.g. with punctate foci of restricted diffusion) [Figures 1a-d and 2a]. A 30  flexion noncontrast MRI demonstrated posterior extradural space expansion due to an engorged epidural venous plexus, with anterior displacement at the C4-C6 level [Figure 2b].
Two-year MRI follow-up after surgery on neutral position. (a) Sagittal T2-TSE-weighted image depicting segmental spinal cord atrophy at C5-C6 level (arrows). (b) Axial T2-GRE- weighted acquisition at C5 level with evidence of bilateral medullary hyperintensity of the anterior horns.
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F3
Over the next 2 years, the subsequent MRI scans showed a mild progressive focal atrophy of the cord at the C5-C6 level with selective involvement of the anterior horns [Figure 3].