Cervical neural foraminal canal stenosis: computerized tomographic myelography diagnosis

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✓ The surgical and computerized tomographic myelography (CTM) features of 134 stenotic foraminal canals were correlated retrospectively in 95 patients. The myelographic site of stenosis was the entrance to the foraminal canal in 70 cases (52%) and the canal itself in 37 (28%); the site was not identified definitively in 27 (20%). At the entrance to the foraminal canal, encroachment on the adjacent nerve root was by a cartilaginous cap in 10 cases (8%), a bony osteophyte in 17 (13%), a synovial cyst in one (1%), and a combination of a bony and cartilaginous osteophyte in 42 (31%). The diagnostic features of stenosis within the foraminal canal were more variable. Small bone spurs arising from the uncovertebral process encroached on the anterior aspect of the foramen in 29 instances (22%), accompanied in all cases by either a congenitally narrow canal (in 16) or a diffuse osteophytically narrowed canal (in 13); osteophytes arising from the superior facet in eight instances (6%) were larger and encroached on the posterior aspect of the foramen. Diagnosis on the basis of CTM is difficult because stenosis was readily evident as a bone spur in only 13% of cases, could not be distinguished from prolapsed disc in 39%, had to be differentiated from a congenitally narrow foraminal canal in 27%, and was frankly missed in 20% of the instances of stenosis.

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Address reprint requests to: O. Wayne Houser, M.D., Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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Figures

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    a—c: Computerized tomographic myelography images showing cervical neural foraminal canal stenosis. a: Left uncovertebral spur with a cartilaginous cap resembling a spur with a superimposed extruded disc. b: Uncovertebral osteophyte impinging on the entrance to the left foraminal canal. c: Unossified cartilaginous cap impinging on the entrance to the left neural foraminal canal and resembling extruded cervical disc. d: Axial magnetic resonance T2*-weighted oblique image in the same case as c, also revealing encroachment by the cartilaginous cap that possesses little T2-weighted signal.

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    Computerized tomographic myelography scan (left), T1-weighted magnetic resonance (MR) image (center), and T2*-weighted MR image (right) showing right lateral encroachment on the right thecal sac and C-7 root sleeve by an arachnoid cyst.

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    Computerized tomographic myelography scans. Left: Left neural foraminal stenosis due to small uncovertebral osteophytes (arrows) superimposed on a narrow foraminal canal. Right: Generalized hypertrophy of an uncovertebral process that narrows the C-6 foramen and traps the adjacent nerve root.

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    Computerized tomographic myelography scans showing foraminal stenosis. Left: Stenosis at C-5 due to generalized hypertrophy of facets and a small spur (arrow) impinging on the lateral aspect of the foramen. Center and Right: Soft tissue (center) and bone (right) window scans showing marked facetal degeneration with large bone spurs encroaching on the lateral aspect of the right neural foraminal canal.

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    Computerized tomographic myelography image showing bilateral congenitally narrow cervical foraminal canal. Note the smooth, sharply defined medial and lateral walls. The patient was asymptomatic.

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