Presentation
Tingling, numbness and weakness in the hands. Unknown time of onset.
Patient Data
Alignment: Straightening of the cervical spine without significant spondylolisthesis.
Vertebra: Normal number and configuration. No significant vertebral body height loss.
Disc spaces: Disc space narrowing at C4-C5, C5-C6 and C6-C7.
Spinal canal: Mild congenital narrowing of the spinal canal with superimposed degenerative changes resulting in cord compression at C3-C4 and C4-C5. No evidence of abnormal spinal cord signal.
Spinal levels as detailed below:
C2-C3 disc space: No disc herniation. Uncovertebral arthrosis contributes to mild left foraminal narrowing.
C3-C4 disc space: Large central disc protrusion resulting in severe spinal canal stenosis and cord compression with ventral cord deformity. No cord signal abnormality. Uncovertebral arthrosis contributes to moderate left and mild right foraminal narrowing.
C4-C5 disc space: Disc osteophyte complex resulting in mild cord compression and ventral cord deformity. Moderate to severe spinal canal stenosis. Facet/uncovertebral arthrosis contributes to severe left and mild right foraminal narrowing.
C5-C6 disc space: Disc osteophyte complex and facet/uncovertebral arthrosis with mild spinal canal stenosis, and severe left foraminal narrowing.
C6-C7 disc space: Disc osteophyte complex and facet/uncovertebral arthrosis without spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing.
C7-T1 disc space: No disc herniation, spinal canal stenosis or high-grade foraminal narrowing.
Case Discussion
This represents a case of multilevel cervical spondylosis. The patient, with no significant medical history, presented to the emergency department with numbness, tingling, and weakness in the bilateral arms. He also reported occasional pain in the neck radiating the arms upon movement.
MRI of the cervical spine confirmed spondylosis. The patient was treated with a low dose of prednisone, NSAIDs, and baclofen. He was discharged with a referral for physical therapy.
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