A subsequent diagnosis of C3/C4 and C4/C5 severe cervical canal stenosis with spinal compressive myelopathy was made.įollowing a literature review, we identified no other similar cases so this appears to be a unique sequence of presentation. Cerebrospinal fluid effacement and cord signals were demonstrated with myelomalacia. There was associated intrinsic signaling consistent with cervical myelopathy. An initial MRI scan showed a central posterior disc bulge at the C3/C4 level with the disc partially indenting the cord and a large posterior disc osteophyte complex at the C4/C5 level, which was compressing the cord ( Figures 1– 4). Examination of the cranial nerves was unremarkable. All reflexes (knee, biceps, and triceps) were brisk. Romberg test was weakly positive, and Hoffman test was positive, mainly on the left side. Initial examination showed a full range of movement in his neck and shoulders. He had no history of poor balance, unsteadiness, or dropping objects however, he had reduced exercise tolerance as he developed paresthesia of the legs while cycling. This fine motor skill decline then progressed to numbness affecting the hands and feet bilaterally and he developed persistent tiredness and weakness affecting all 4 limbs. As a music teacher, the patient was regularly playing the guitar with the neck in a hyperextended position. We present a unique case with clinical manifestations and magnetic resonance imaging (MRI) findings of compressive cervical myelopathy and underwent ACDF however, he had an eventual diagnosis of multiple sclerosis with recurrent symptoms postoperatively.Ī 41-year-old male, otherwise fit and healthy, presented to clinic after his musical colleagues noted that his guitar playing ability had reduced over the past 9 months. 4 Many of the clinical manifestations of cervical myelopathy may also mimic other neurological disorders and due to this, it remains undiagnosed or underdiagnosed 5 in the general population and is often only diagnosed when the disease has significantly progressed clinically or radiologically. 3 As a result, ACDF has long been regarded as the gold standard for the management of single or multilevel cervical vertebral disease associated with compressive myelo-radiculopathy. 1 Since Smith and Robinson 2 first introduced anterior cervical discectomy and fusion (ACDF) in the 1950s, an increasing number of operations have been performed in the United Kingdom each year. Cervical spondylosis and other related disorders are increasing in prevalence in Western society.
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