Imaging Findings: The sagittal MR images show a significant lesion at C4-5 and mild dorsal deviation of the spinal cord at C2-3.

Discussion: The compression at C4-5 is consistent with a herniated disk (see Image 1) and the patient's signs. A spinal tumor is unlikely because a brighter signal for the lesion would be expected on the T2 image since tumors have higher water content than herniated disk material. The bright signal above the spine is typical of both T1 and T2-weighted images and is not a sign of cervical muscle inflammation. There could be a mild disk bulge at C2-3 but this is often normal on sagittal images. From this angle alone, it cannot be determined if it is significant enough to contribute to the patient's signs. Axial images were needed to better evaluate the space (see Image 2).

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Click to enlarge  Image 1 Image 2

Imaging Findings: The axial image shows no evidence of spinal cord compression at the C2-3 disk space.

Diagnosis: Intervertebral disk herniation at C4-5, malformed C3-4 block vertebrae.

Treatment: A C4-5 ventral slot was done to remove the herniated material and the spinal cord was decompressed. One day following surgery, the patient had improved significantly. Sutures were removed two weeks later, at which time, there were no neurological deficits. The gait had returned to normal and the patient was able to move the head and neck well without pain.