Female, 72 years old, with history of cervical chordoma status post treatment with proton radiotherapy, under good control, but with recent neurologic decline including frequent falls and left-sided weakness and proximal lower extremity weakness. Status post C2-C7 decompression and fusion. Assess for ischemia, postoperative changes. Sequelae of recent laminectomy from C2 through C6 are demonstrated. Posterior fusion instruments have also been placed from C2 to C7. As a result of the procedure, the previously seen cervical spinal canal stenosis has been relieved and the progressive kyphotic angulation of the spine has improved. A small amount of fluid is evident within the posterior soft tissues along the dura at C2 and C3. A surgical drain is evident in the operative bed.The marrow space of the cervical spine shows diffuse fatty infiltration compatible with prior radiation therapy. Superimposed on this is marrow replacement involving C3, C4, and C5, with small foci in the remaining vertebral bodies extending down to T1.As above, the spinal canal has been well decompressed and the spinal cord is no longer frankly impinged by disc osteophyte disease. However, extensive central cord T2 hyperintensity spanning from the obex down to the upper thoracic region has not significantly changed from the recent prior exam.C2-3: Spinal canal decompression. No significant foraminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. Note is made of a cystic lesion which appears to protrude into the paraspinal soft tissues from the right neural foramen which may represent a perineural root sleeve cyst, unchanged from prior.C4-5: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. C5-6: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C6-7: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C7-T1: Posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. No significant spinal canal stenosis.
1.Sequelae of extensive cervical spine laminectomy and posterior instrumented fusion. Previously seen spinal canal stenosis has been relieved, and the progressive cervical kyphosis has been partially corrected.2.The spinal canal is now well decompressed and no areas of spinal cord impingement are seen. However, extensive central cord T2 signal abnormality persists, similar to the prior examination, extending from the obex down to the thoracic region. The differential for this finding would include cord ischemia with or without a component of compressive myelopathy. Radiation related myelopathy would be less likely given the history of proton therapy, but correlation with radiation timing and treatment fields should be made to better judge this possibility. Additional inflammatory etiologies may also be considered as appropriate for the clinical history.3.On a background of prior radiation marrow change, patchy areas of marrow replacement persist from C3 through C5 predominantly, but with small foci in the remaining visualized cervical vertebral bodies. These lesions may reflect residual or treated chordoma.