Fig 1. A 46-year-old man with neck pain after minor trauma.

AP (A) and lateral (B) radiographs show a densely sclerotic right paravertebral mass extending from the C5 to T1 level. Coronal (C), right parasagittal (D), and axial (G) CT images show undulating zones of cortical hyperostosis with a "dripping candle wax" appearance involving the right sides of the C5–T1 vertebrae with extension over the right facet joints of C4–C5 to C7–T1. The hyperostosis involves the vertebral bodies, right laminae and transverse processes, and right sides of the spinous processes. The expansile cortical hyperostosis extends mostly peripherally along the outer bone surface but also involves the endosteal margins resulting in prominent narrowing of the involved marrow space. Posterior vertebral body osteophytes at C3–C4 and narrowing of the right C5–C6 foramen from the hyperostosis are also evident. Right parasagittal (E) T1-weighted (TR 450, TE 9), right parasagittal (F) T2-weighted (TR 1800, TE 110), axial (H) T2-weighted (TR 4000, TE 100), and axial (I) postgadolinium-contrast (Gadoteridol) T1-weighted (TR 450, TE 9) MR images obtained 7 years after the radiographs and CT images above show zones of signal intensity void on all pulse sequences with no enhancement corresponding to the areas of hyperostosis seen on radiographs and CT scans. A posterior spondylotic ridge at C3–C4 (F) is seen. Sagittal, midline (J) T2-weighted (TR, 1800; TE, 110) MR image shows the posterior spondylotic ridge at C3–C4 to result in spinal stenosis, which is likely secondary to the fused spinal column from melorheostosis immediately below this level. No signal intensity abnormalities, however, are seen in the spinal cord related to the spinal stenosis at C3–C4 or from the melorheostosis involving the lower cervical levels.