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| | Clinical history | Symptoms | X-ray | CT scans | MRI | Diagnostic | Treatment and follow-up |
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| ROP from atlantoaxial instability | Elderly patients.
Long term neck injury with atlantoaxial suluxation.
Fracture of the odontoid process.
Os odontoideum. | Usually asymptomatic.
Chronic
cervical pain. | Dynamic study of atlantoaxial instability.
Ossification of anterior longitudinal ligament.
Ankylosis. | Degenerative changes:
(i) Disco-uncarthrosis.
(ii) Interarticular posterior arthrosis.
(iii) Osteophytosis
(iv) Atlantoaxial subluxation
(v) Space available for spinal cord (SAC)
Ankylosis. | ROP is hypo- to iso intense on T1w and predominantly hypo intense or mixed intensity on T2w. | Fibrous or cartilaginous nature.
Degenerated ligaments. | Posterior cervical fixation results in immediate postoperative neurological improvement. |
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| Rhumatoid or psoriasitic arthritis (RA) | History of rhumatoid or psoriasitic arthritis. | Long standing and progressive neurologic deficits.
Types 1 and 3 disappears faster than type 2. | Dynamic X-rays: severe atlantoaxial subluxation during flexion. | Erosive alterations. | Pannus predominates anteriorly to the dens, surrounds the eroded odontoid process.
3 types exists:
(1) pannus in low signal in T1w and high signal in T2w with enhancement post contrast administration.
(2) pseudotumour in low signal in T2w and T1w.
(3) mixed with combination of high and low signal in T2w. | | Spontaneous resolution or diminution of retrodental pannus after posterior atlantoaxial stabilisation. |
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| Retro-odontoid cysts | Elderly patients with degenerative spine disease. | | | | Cystic and hypertrophic degeneration of the transverse ligament of axis.
We can differentiate this pattern from synovial cyst with echo-gradient T2-weighted images on MRI showing hemosiderin deposits and no or thin enhancement. | Transverse ligament develops granuloma formation and angiogenesis, with chronic recurrent micro hemorrhages in case of rupture, leading to cyst formation. | Excision of the cystic lesion by a trans condylar approach. |
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| Gouty deposits | History of goutt (acute peripheral arthritis)
Hyperuricemia. | Lombalgy > cervicalgy.
All spine components can be affected.
Long standing and progressive neurologic deficits. | Cord compression on myelogram. | Erosive lesion.
Tohpus is hyperdense on CT, with positive diagnostic to crystal of uric acid on Dual Energy CT. | Extradural intraspinal cervical fibrous tophus, in hypo to intermediate on T1w, hypo- or hyper signal on T2w with diffuse enhancement.
Ventral and lateral position to the cord.
Ligament softening.
Subluxation C1-C2. | Histological results showing crystals of uric acid, multinucleate giant cell and histiocyte proliferation.
Macroscopically, whitish and chalky material. | Progressive clinical improvement. |
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| Amyloidosis | History of long-term hemodialysis, multiple myeloma, chronic inflammatory diseases, chronic infection. | Joints pains that mimic rheumatologic disorders. | Proeminent erosive alterations. | Dorsal vertebral > lombar spine > cervical spine. | Soft tissue intra neural mass with in low intensity T1w images and hypo- or mixed intensity in T2w images.
Paraspinal extension.
Severe medullary cord compression is possible. | Extracellular deposition of amyloid, with normal serum amyloid associated protein.
Tissue biopsy: green birefringent fibrils by polarization microscopy after staining with Congo red. | Pronostic depends of the type of amyloidosis: primary solitary amyloidosis has best recovery and of lack of recurrence with a complete resolution of amyloidoma after surgical treatment. |
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| Pigmented villonodular synovitis | Uncommon
Young adults
Knee > hip > ankle > shoulder. | Long standing and progressive neurologic deficits. | Mass epidural between the posterior longitudinal ligament and the vertebral bodies on cervical myelogram. | No erosion. | ROP hypo intense T1. | | No data. |
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| Epidural lipomatosis | Diffuse overgrowth of nonencapsulated adipose tissue in the epidural space:
(i) Severe obese patients.
(ii) Longstanding high-dose > low dose steroid therapy (iatrogenic Cushing’s syndrome). | Long standing and progressive neurologic deficits. | | Fatty epidural mass with mean density of -100 to -50 HU. | Massive diffuse epidural fat compressing the entire spinal cord in hyper signal T1/T2, hypo signal in STIR.
Ventral displacement of the cord.
Ischemic myelopathy
with central gray matter hyper signal T2w in thoracic region. | | No data. |
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| Forestier’s disease | Older men.
Diffuse idiopathic skeletal hyperostosis (DISH). | Progressive neurologic symptoms resulting from anterior cervicomedullary junction. | Massive anterior longitudinal ligament calcification with bridge on the anterior border of the thoracic and subaxial cervical spine. | Massive anterior longitudinal ligament (ALL) calcification with bridge on the anterior border of the thoracic and subaxial cervical spine. | Calcification of ALL shows hypo signal in all sequences T1/T2/STIR and no enhancement.
Permits to differenciate with shiny corner in ankylosing spondylitis. | Hypertrophic degenerative cartilage. | Transoral resection of the ligamentous mass followed by occipitocervical fusion.
Early postoperative neurological improvement. |
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