Female, 47 years old, with neck pain after motor vehicle collision. Evaluate for ligamentous injury and for spinal metastases. Pathologic marrow replacement and enhancement is seen throughout the visualized osseous structures. In particular, the vertebral bodies are diffusely involved including the right lateral mass of C1 and the right occipital condyle. The posterior elements are also involved to a lesser degree. Moderate compression deformities are evident at C4 and C5, with severe compression deformities at T3 and T4. None of these levels shows evidence of significant edema suggesting that deformities are chronic. The compression deformity at C4 results in mild retropulsion and at most a very mild compromise of the spinal canal. At T3 and T4, there is a more substantial retropulsion with possible epidural tumor spread resulting in moderate narrowing of the spinal canal.The cervical spine demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is appreciated.Spinal alignment in the cervical region is grossly anatomic accounting for the compression deformities. In the upper thoracic region, there is exaggeration of the normal kyphosis due to compression deformities.C2-3: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Moderate bilateral foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation asymmetric to the left paracentral region with effacement of the ventral thecal sac. Moderate left foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1.Pathologic marrow replacement and enhancement is seen throughout the osseous structures compatible with widespread osseous metastatic disease.2.At C4 and C5, there are moderate compression deformities which cause only minimal encroachment upon the spinal canal.3.At T3 and T4, there are severe compression deformities which, through retropulsion and perhaps some degree of epidural tumor spread, cause a moderate degree of spinal canal narrowing.