Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided lateral X-ray, CT, and MRI images of the cervical spine, multiple gas-containing lesions (indicated by arrows) can be observed in the cervical vertebrae, primarily located within the vertebral bodies, especially near the endplates. The specific findings are as follows:

• On the lateral X-ray of the mid-cervical region (approximately C4-C6), there are lucent lesions in the vertebral bodies that contrast with the surrounding bone density, suggesting possible gas or cavitary structures.
• Coronal and axial CT images more clearly show these lucent areas as low-density or gas-density regions, sharply demarcated from surrounding bone, with some areas showing linear connections to the intervertebral disc space or the vertebral endplate.
• Corresponding areas on MRI appear as signal voids, showing low or mixed signal intensity on both T1WI and T2WI, consistent with gas lesions in the vertebral bodies; adjacent intervertebral discs also show degenerative changes typical of aging.
• Additionally, degenerative changes of the cervical spine are noted, including disc space narrowing, marginal osteophytes, and mild soft tissue degeneration. No clear evidence of malignant tumor or extensive infection is identified at present.
• The patient presents with left brachial plexus pain (radiating pain in the left upper limb), so possible nerve root compression should be considered. MRI does not indicate a significant mass lesion or obvious intraspinal compression.

II. Potential Diagnoses

Based on the clinical and imaging findings, the following diagnoses or differential diagnoses are considered:

1. Vertebral Pneumatocyst
   • Commonly associated with degenerative disc disease, in which gas from the intervertebral disc may enter the vertebral body through endplate fissures, forming gas-filled cysts. In this case, multiple lesions closely related to the endplates are consistent with reported cases.
2. Vertebral Body Osteonecrosis (Kummell’s Disease) or Infection-related Gas
   • In Kummell’s disease, vertebral collapse due to avascular necrosis may present with intravertebral gas, but typically with marked vertebral height loss or significant bony destruction. Infection (such as pyogenic or anaerobic bacterial infection) can also lead to intravertebral gas, but is usually accompanied by prominent inflammatory response and destructive features.
   • In this case, no obvious bony destruction, vertebral collapse, or signs of infection are noted; with no significant abnormal infection markers, this is less likely.
3. Tumor-related Lesions with Central Necrosis or Gas Production
   • Certain malignant lesions or metastatic tumors may produce central necrosis with gas formation, but they are often accompanied by bone destruction, soft tissue masses, and systemic symptoms.
   • Combining the imaging and clinical presentation in this case, there is no evidence suggestive of a clear tumor.

III. Most Likely Final Diagnosis

Considering the patient’s age, longstanding degenerative changes of the cervical spine, imaging characteristics, and the absence of signs of infection or malignancy, the most likely diagnosis is: “Degenerative Vertebral Pneumatocyst.”

These cysts are typically benign changes related to intervertebral disc degeneration and endplate defects, with no apparent progressive bone destruction. If infection or tumor is suspected, further tests such as laboratory investigations (e.g., ESR, CRP, tumor markers) or periodic imaging follow-up should be performed.

IV. Treatment Plan and Rehabilitation

Based on current imaging and clinical symptoms, the patient mainly experiences chronic neck pain and radiating pain in the left arm. The following management strategies are recommended:

1. Conservative Treatment
   • If there is no significant worsening of neurological symptoms or severe spinal canal stenosis, conservative treatment is preferred, such as cervical bracing, physical therapy, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.
   • Periodic imaging follow-up is advised to observe any changes in the size of the cysts. If they remain stable or do not significantly enlarge, no further intervention is necessary.
2. Medication Management
   • Oral or topical analgesics and anti-inflammatory medications such as NSAIDs or acetaminophen can help alleviate neck pain and radiating arm pain.
   • If muscle spasms are present, a short course of muscle relaxants may be considered under medical supervision.
3. Surgical Indications
   • If subsequent evaluations reveal progressive nerve compression or intractable pain, assessment for significant foraminal stenosis or nerve root involvement is necessary. Should imaging and clinical findings indicate worsening neurological deficits, surgical interventions such as micro-decompression or fusion may be considered.
4. Rehabilitation and Exercise Prescription
   • Once acute pain subsides, the patient should gradually begin exercises to strengthen the shoulder and neck muscles, including light cervical stabilization training (e.g., isometric contractions).
   • Example Using FITT-VP Principles:
     • Frequency: 3–4 times per week, avoiding prolonged desk work every day and ensuring periodic breaks.
     • Intensity: Start with low intensity (RPE about 2–3 out of 10) and gradually increase as tolerated.
     • Time: Begin with 10–15 minutes per session and progressively lengthen to 30 minutes.
     • Type: Isometric neck strengthening exercises, light dumbbell or resistance band shoulder/neck exercises, and low-impact aerobic activities (e.g., elliptical or brisk walking).
     • Progression: Increase weight or resistance gradually depending on pain relief and fatigue. Maintain proper form and avoid excessive neck rotation and flexion.
   • During any weight-bearing or stretching exercises, closely monitor for changes in neck or arm symptoms. If pain worsens or numbness occurs, seek medical advice or adjust the exercise plan promptly.