Multilevel critical stenosis with minimal functional deficits: a case of cervical spondylotic myelopathy

We present a case of a previously asymptomatic and highly functional individual whose critical degenerative stenosis was exacerbated by recent trauma (motor vehicle accident), resulting in cervical spondylotic myelopathy.

A 57-year-old African-American man with no significant past medical history presented to the Orthopaedic Surgery outpatient clinic with mild neck discomfort, stiffness, and bilateral hand numbness 4 days after being involved in a motor vehicle accident. He ambulated without assistive devices and displayed a tandem gait pattern with normal cadence. He was minimally tender to palpation at the posterior cervical midline and paraspinal musculature with motor and sensory function intact bilaterally. Reflexes were hypoactive at C5, C6, C7, L4, and S1 bilaterally with positive Babinski signs bilaterally. Imaging revealed degenerative changes, spinal stenosis, and cord compression. The patient eventually underwent posterior cervical decompression and fusion from the C3 to the C6 level, with the only reported complication being transient loss of somatosensory evoked potential (SSEP) signals intra-operatively. In the postoperative period, the patient complained of stiffness in his left shoulder, elbow, and hand, as well as left hand palmar numbness and an inability to make a full fist. His complaints were managed with medication and physical therapy.

This case report highlights the point that stenosis that occurs slowly over time is often well compensated, and patients are commonly asymptomatic at first glance. Often times, acute events tip patients from being asymptomatic to symptomatic, generally warranting invasive intervention to prevent further insults from causing permanent damage.