Fig. 11.51 a The spinal canal of this patient is extremely narrow secondarily to severe degenerative changes of the cervical spine with associated malalign-ment. Additional minor trauma was sufficient to induce a severe spinal cord injury with transverse paralysis. b In another patient who sustained minor trauma, signal changes can be seen in the spinal cord extending inferior to the level of the preexisting spinal canal stenosis. In this case the anterior spinal artery, which provides crucial blood supply to the cervical and upper thoracic spinal cord, has been compressed. Ischemia of the spinal cord is a feared complication (anterior spinal artery syndrome).
• Diagnosis: Giufeng and Paul diagnose a slow-growing and well-demarcated intradural extramedullary mass to be at the root of the problem, most likely a meningioma. That is good news for Ann Ray. The neurosurgeons resect the tumor that same day. Three weeks later she is back on her feet—in a rehabilitation clinic undergoing intensive physiotherapy.
Acute paraplegia requires an immediate MRI and subsequent rapid therapy.
Particularly if radicular symptoms are present, imaging findings and clinical symptoms should be seen in conjunction with the imaging findings to come to a sound and correct diagnosis. Many people have one or several herniated disks without ever developing any associated symptoms. Therefore, only the presence of both radicular symptoms and a matching positive finding in the expected corresponding anatomical location suggests a causative relationship with acceptable certainty. A radiograph of the lumbar spine should always be performed to exclude mis-alignments/spondylolisthesis of the spinal column.
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