PMC10060797_01
Severe left-sided C5-6 intervertebral disk extrusion. Sagittal (A) and transverse (B) CT images of the cervical spine illustrate severe mineral-attenuating extradural material in the left ventral aspect of the vertebral canal centered at C5-6 extending cranially to mid-C5 and caudally to C6-7 and subsequent extradural spinal cord compression. The dotted line (A) denotes the axis by which the transverse CT image (B) is reconstructed.
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F1
This CT study demonstrated a severe amount of mineral attenuating extradural material in the left ventral aspect of the vertebral canal extending from the level of mid C5 to C6-7, causing severe rightward dorsal displacement and extradural compression of the spinal cord, suggestive of severe left-sided C5-6 intervertebral disk extrusion (Figure 1).
Ascending/descending cervical myelomalacia. Sagittal (A) and transverse (B) T2W images show severe diffusely and heterogeneously increased intramedullary T2W signal intensity within the cervical spinal cord centered over the gray matter. Notably, the recent C5-6 and C6-7 hemilaminectomy sites characterized by ostectomy and local soft tissue thickening and increased signal intensity (A, B). Sagittal HASTE image (C) shows complete and circumferential attenuation of the cervical subarachnoid space from the level of mid-C2 beyond the caudal limit of the study (level of T2), suggestive of extensive spinal cord swelling. Pre-contrast sagittal T1W (D), post-contrast sagittal T1W (E), and post-contrast transverse T1W (F) images demonstrate ill-defined and heterogeneous intraparenchymal contrast enhancement centered over the gray matter from the level of C2-3 through mid C4. The dotted line (E) denotes the axis by which the post-contrast T1W image is acquired.
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F2
There was no evidence of a T2W*susceptibility artifact identified in the study. These MRI findings were consistent with imaging findings associated with progressive myelomalacia in the thoracolumbar spine, as well as ischemic necrosis (Figure 2).
Photomicrograph of the cervical spinal cord with multifocal hemorrhage, severe tissue loss, cavitation, and lack of distinction between the gray and white matter. H&E stain.
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F3
This was attributed to acute necrosis, multifocal to coalescing hemorrhage, loss of tissue with occasional cavitation, and mild neutrophilic inflammation (Figure 3).
Higher magnification of microscopic changes in the cervical spinal cord. Within the gray matter (A), there is neuropil rarefaction and vacuolation with low numbers of residual neurons being angular and hypereosinophilic with no nucleus (arrow, necrosis). Within the white matter (B), there is swelling and hypereosinophilia of axons and marked distension of myelin sheaths, some of which lack axons (axonal loss). In both the gray and white matter, there is multifocal hemorrhage, scattered infiltration by low numbers of neutrophils, and multiple vessel walls are partial to fully obscured by bright eosinophilic fibrillary material (arrow head, fibrinoid vascular necrosis). H&E stain.
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F4
In some less severely affected spinal sections, the residual white matter was often comprised of multiple swollen axon sheaths containing swollen hypereosinophilic and glassy axons (spheroids) and rare macrophages (digestion chambers) or was empty from axonal dropout (Figure 4).