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Intervertebral Disc Protrusion Masquerading as an Intramedullary Tumour

Department of Radiology of the Boston Veterans Administration Hospital, Boston, Massachusetts, U.S.A.

This excerpt was created in the absence of an abstract.

It is well known that herniated discs in the lumbar region may simulate a tumour mass on myelography. It is less well known that a herniated disc in the cervical region may under certain conditions present myelographic changes characteristic of an intramedullary lesion. Our purpose in reporting such a case is to draw attention to the misleading appearance of a remediable lesion as an inoperable one and to give a geometrical explanation for the similar appearance of the two kinds of lesions.

A man, aged 40, who had had a ruptured lumbar intervertebral disc excised ten years previously, noticed increasing pain in the neck and left shoulder, radiating to the forearm and medical fingers. The pain was aggravated by coughing, sneezing, or straining, and the left arm was weak. On examination the triceps was found to be weak and its tendon-jerk absent. There was sensory loss in the distribution of the 7th cervical nerve. There were no symptoms or signs referable to the back, sphincters, or lower limbs. On films of the cervical spine the vertebral bodies appeared normal; there was no narrowing of any of the disc spaces or localised widening of the spinal canal. Cervical myelography showed apparent widening of the spinal cord at the C6-C7 level (Fig. 1). Oblique and lateral views (Figs. 2 and 3) revealed no indentation of the anterior or lateral margins of the opaque column. No block was found.