Fig. 7
A 65-year-old male patient complaining of neck pain with mJOA score = 13 (Moderate grade). A Conventional MRI: Sagittal T2WI, B Sagittal T1WI C Axial T2WI at CV4/5 level D Axial T2WI at CV5/6 level, Sagittal DTI: E ADC map, F FA grayscale map G FA color map, H 3D tractography. A, B Sagittal T2WI A and sagittal T1WI B showing multilevel bulky diffuse osteophytic disc complex bulge at CV3/4 through CV6/7 more opposite CV4/5 disc level encroaching upon the sub arachnoid space with narrowing of both neural exit foramen the condition is augmented by hypertrophied ligamentum flavum with 2ry canal stenosis. Those disc levels are seen severely compressing the related portion of the cervical cord (3rd degree) more notably at CV4/5 were corresponding type I T2 hyperintense cord signal (white arrow) measuring about 8.5 mm in size, no abnormal cord signal at T1WI (compressive cord myelopathy grade II). C, D axial T2WI at CV4/5 (C) and at CV5/6 (D) Showing bulky diffuse osteophytic disc complex bulge with central disc protrusion of those disc levels indenting the subarachnoid space and compressing the related cord with abnormal high T2 cord opposite CV4/5 level (Grade II). E Sagittal ADC map showing high ADC value at site of cord myelopathy CV4/5 (represented by arrow) = 1.22 × 10–3 mm2/s compared to 0.82 × 10–3 mm2/s at non-compressive site. F Sagittal FA grayscale map showing low FA value at site of cord myelopathy (CV4/5) 0.48 (moderate FA) compared to 0.67 at non-compressive site. G FA color map showing indention of cord at FA color map with faint green color at site of cord myelopathy (CV4/5). H 3D tractography showing homogenous color of the cervical cord and intact fiber tracts (grade I)