This is a 49-year-old female who presented to our clinic with
chief complaints of difficulty with gait, bilateral upper extremity
weakness and numbness. Symptom duration was approximately four months.
She had recently undergone a carpal tunnel release one month prior
to my seeing her for carpal tunnel syndrome as an etiology of her
right hand numbness. She saw no improvement from this procedure.
Prior to her onset of symptoms she was very active. At the time
of presentation, she had great difficulty ambulating even short
distances. Physical examination revealed a positive Lhermitte's
sign. She exhibited diffuse, global upper extremity weakness. Her
gait was very uncoordinated and spastic. She had sustained clonus
of her right lower extremity and 3 beats of clonus on the left.
She had a positive Babinski's sign on the right. Hoffman's reflex
was positive bilaterally in her upper extremities.
Differential diagnosis at that time was amyotrophic lateral sclerosis,
multiple sclerosis, spinal neoplasm and cervical myelopathy.
MRI scan was obtained of her cervical and thoracic spine. This
revealed severe cervical spinal stenosis with a marked narrowing
of the cervical spinal canal from C4 to C7, with substantial signal
change within the spinal cord. Final diagnosis was cervical spondylotic
She underwent a two level anterior cervical corpectomy with fibular
allograft strutting and anterior plating shortly after diagnosis
was made. She had no perioperative complications and was discharged
home on her second post-operative day.
At three month surgical follow up, her gait was found to be markedly
improved to the point that she was able to resume exercise and walk
three-fourths a mile per day. While her gait had clinically improved,
she still had overt signs of spasticity upon clinical examination.
She continued to have bilateral clonus worse on the right. Upper
extremity strength returned to normal bilaterally. Upper extremity
sensation was also noted to improve but not completely return to
normal at three-month follow up.
Cervical spondylotic myelo-pathy is very responsive to surgical
intervention, particularly if caught in the early stages. This patient
had more advanced myelopathy and, therefore, I would not expect
a full return of normal neurologic function. Long-term clinical
follow up series show that the great majority of these patients
will improve and that the surgery almost universally arrests the
progression of the myelopathy. The key to successful treatment remains
early diagnosis and intervention.
Axial MRI sections from the C4-C5, C5-C6, C6-C7 interspace
revealing severe acquired cervical stenosis.
Saggital MRI revealing cervical spinal stenosis from
C4 to C7 and the marked signal change within the spinal
Lateral post-operative x-ray showing the fibular strut
graft in position with an anterior cervical plate.