Medical Imaging Analysis Report

1. Radiological Findings

From the provided X-ray, CT, and MRI images, the following observations are made:

• Degenerative changes are noted in the cervical spine (especially the mid to lower segments), with a certain degree of osteophyte formation at the intervertebral discs and vertebral margins.
• On the CT images, there is a near-round or round cystic lesion with relatively clear boundaries in the posterolateral portion of the spinal canal, located near the adjacent facet joints (zygapophyseal joints). It appears as a “cystic” density and may contain fluid density resembling cerebrospinal fluid or gas density (in some cases, calcification or high-density changes may be present).
• On MRI, the cystic lesion shows high signal intensity on T2-weighted images, similar to that of fluid; the cyst wall margin may exhibit a low signal, suggesting fibrous or calcific content. The lesion is closely related to adjacent ligaments (e.g., ligamentum flavum) and can exert pressure on the posterolateral margin of the dural sac, leading to local narrowing of the spinal canal.
• Clinically, the patient presents with painful numbness in both hands, decreased muscle strength in the upper limbs, and weakness in the lower limbs—more pronounced on the right side, showing mild paresis. These symptoms suggest compression or irritation of neural structures.

2. Potential Diagnoses

Based on the patient’s imaging findings and clinical symptoms, the following possible diagnoses are considered:

1. Synovial Cyst / Ganglion Cyst adjacent to the Facet Joint
   • Typically occurs near degenerative facet joints, closely connected to the joint capsule or ligaments, often containing synovial fluid or mucinous material.
   • On imaging, usually appears as a cystic lesion matching the degenerative changes of the adjacent facet joint; can cause corresponding local nerve compression symptoms.
2. Intervertebral Disc Herniation (posterior or sequestered type)
   • Although it can also show an intraspinal occupying effect, most herniated discs on imaging are connected to the intervertebral disc and generally appear as soft tissue density.
   • Sequestered fragments typically appear lobulated and do not show a definite link to the facet joint.
3. Schwannoma
   • This tumor often appears within the spinal canal, usually showing a homogeneous signal or enhancement pattern.
   • It is associated with the nerve roots passing through the intervertebral foramen rather than specifically linked to a degenerative facet joint.
4. Perineural Cyst
   • May also present as a cystic lesion within the spinal canal but generally has a closer relationship with the nerve root sheath.
   • More commonly found in the sacral canal or lumbar region.

3. Final Diagnosis

Taking into account the patient’s age, clinical presentation, radiological changes, and the lesion’s location and characteristics, the most likely diagnosis is an intraspinal synovial cyst near the cervical facet joint, often referred to as a facet joint synovial cyst or facet joint cyst. This lesion is related to the degenerative facet joint, potentially causing spinal cord or nerve root compression symptoms. Its imaging features are consistent with the patient’s clinical presentation.

4. Treatment Plan and Rehabilitation Program

1. Treatment Strategies

• Conservative Treatment: For mild symptoms, during acute episodes, consider analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and wearing a cervical brace to limit unnecessary neck movements.
• Local Injection Therapy: Under imaging guidance, perform aspiration of the joint space or the cyst cavity and inject steroids to relieve inflammation and pain.
• Surgical Treatment: If nerve compression is severe or symptoms significantly affect quality of life, surgical removal of the cyst with decompression may be necessary. In some cases, facet fusion or stabilization procedures might be performed.

2. Rehabilitation / Exercise Prescription (FITT-VP Principle)

• Frequency: Begin with 2–3 sessions per week, avoiding periods of persistent pain or acute exacerbation.
• Intensity: Start at low to moderate intensity, adjusting according to the patient’s tolerance and spinal stability. Avoid frequent extreme neck motions.
• Time: About 20–30 minutes each session initially, progressing to around 40 minutes based on the patient’s fatigue level and symptoms.
• Type:
  • Focus on cervical core muscle training, such as low-intensity isometric neck exercises and gentle shoulder/neck stretches.
  • Perform flexibility exercises (e.g., shoulder rolls, cat-camel stretch) slowly and within a small range of motion.
  • Include light lower limb endurance exercises (e.g., walking on flat ground, gentle pedaling in a standing position) to avoid excessive leg strain.
• Progression:
  • As neck pain and numbness subside, gradually increase exercise intensity or duration.
  • Emphasize maintaining cervical spine stability and preventing new injuries.

Note: Patients with severe osteoporosis, cardiopulmonary conditions, or other comorbidities should gradually increase exercise under the guidance of a professional physician or rehabilitation therapist, based on a safety assessment.