A 43 year-old man developed neck pain radiating to both shoulders. Gait was stiff and awkward.  Examination was notable for increased reflexes in the arms and legs, and bilateral Babinski responses.

Sagittal MRI scan of the cervical spine. (Left) T1-weighted; (Right) T2-weighted. Note the large disk herniation between the C3 and C4 vertebral bodies, deforming the spinal cord at that level. Also note the effacement of the CSF both anteriorly and posteriorly, best seen on the T2-weighted scan (where CSF is bright).