After 4 years of trying, I finally got my sitting MRI to show what’s going on in my neck when gravity is pulling on it. Still waiting for styloid measurements. Here’s the report if anyone has feedback before my follow up wuth Dr. H on 5/5:
"Exam: MRI CRANIO-CERVICAL JUNTION FLEX/EXT WO CLINICAL HISTORY: Fifth and sixth cranial nerve impingement with carotid and jugular impingement. Evaluate for instability. History of Eagle’s syndrome.
TECHNIQUE: Sagittal T1, sagittal T2, axial proton density, coronal proton density, and flexion and extension sagittal T2 weighted images were obtained in the neutral sitting position for a craniocervical junction MRI.
FINDINGS: On flexion and extension imaging, there is posterolisthesis of C3 on C4 by 3.5 mm on extension positioning consistent with ligamentous instability/laxity. No marrow or soft tissue edema lesions or cord lesions. The cerebellar tonsils are within normal limits and position with no evidence of Chiari malformation.
The Grabb-Oakes measurement was performed. On neutral position images, it is 7 mm. This increases to 9.5 mm on flexion position images which is abnormal. There is direct impingement upon the ventral cord on flexion positioning in the region of C1-C2. On extension, the Grabb-Oakes measurement is 4.2 mm. These findings are consistent with instability. There is no signal abnormality of the brainstem on T2 weighted images.
The clivo-axial angle is 138 degrees on flexion, 136.7 degrees on neutral, and 128.2 degrees on extension position images. The atlantodental interval shows asymmetry of the periodontoid space with a transverse dimension on the right measuring 6 mm and on the left measuring 3.8 mm.
No os odontoideum or bone erosion of the odontoid.
IMPRESSION: 1. 2. 3. 4. 5. 6. 7. Straightening of the normal cervical lordotic curvature which can be seen with muscle spasm due to ligamentous sprain and/or disc injury. Posterolisthesis of C3 on C4 on extension positioning, significant in degree. In the setting of trauma/injury, malalignment to this degree can be seen with Alteration of Motion Segment Integrity/Loss of Motion Segment Integrity due to acute/subacute ligamentous sprain and laxity of the ligamentous structures. Impingement upon the cord at C1-C2 by the odontoid on flexion position images.
The GrabbOakes measurement is 7 mm on neutral positioning, increasing to 9.5 mm on flexion positioning, and decreasing to 4.2 mm on extension positioning. On neutral, flexion, and extension positioning, the clivo-axial angle is 136.7, 138, and 128.2 degrees respectively.
No Chiari malformation. No brainstem lesions. Asymmetry of the periodontoid space/atlantodental interval. This may indicate ligamentous injury to the alar ligaments."