Can't Button Shirt

The patient is a 65 year-old male who presented with a two-year history of progressive difficulty walking and using his hands. He was unable to cut his steak and could not button his shirt. On exam he had a spastic, unsteady gait and difficulty picking up a dime from the formica countertop. He had mild weakness in all four extremities, a positive Hoffman sign and four beats of clonus. MRI of the cervical spine showed severe multi-level stenosis with evidence of long-standing spinal cord compression (see preoperative MRI). A posterior cervical decompression was performed by removing the lamina from C3 to C6. Two years after surgery the patient's dexterity has improved and he is now able to remove the keys from his pants pocket and can feed himself. His gait has improved but he remains spastic. Continued spasticity is indicative of permanent spinal cord injury secondary to prolonged compression from cervical spondylosis / arthritis. The patient's strength, balance and dexterity improved after surgery but has not returned to normal after one and half years.

This is a preoperative MRI image in the sagittal plane that shows severe multi-level cervical arthritis causing compression of the spinal cord (straight red arrow). The curved arrow points to bruising within the spinal cord from arthritis for which the patient required a posterior cervical decompression.

This a post operative MRI image in the sagittal plane of the cervical spine. The straight arrow points to a now generous subarachnoid space with evidence of complete decompression of the spinal cord. The curved arrow shows persistent evidence of spinal cord damage that may occur with prolonged compression secondary to cervical spondylosis or arthritis in the bones of the neck.