An Uncommon Presentation of Cervical Myelopathy

Cervical myelopathy is a compressive spinal cord disease usually affecting individuals 55 and older. Involvement of C5-C7 is typical and classically presents with hand clumsiness, wide-based gait, and paresis. We present the case of a 38-year-old man with a pertinent history of a previous motor vehicle accident who presented to the emergency department for progressive numbness, weakness, and severe spasms in both lower extremities, and eventually developed bowel and bladder incontinence. Lumbar magnetic resonance imaging (MRI) showed moderate L3-L4/L5-S1 degenerative spinal changes; however, cervical MRI demonstrated severe C6-C7 spinal stenosis. The patient did not present with any upper extremity neurological changes. Given the relatively mild changes in the lumbar spine, the patient was concluded to have lower extremity and autonomic neurological issues due to severe cervical spinal stenosis. In this report, we present a relatively common case of cervical myelopathy and myelomalacia in a patient unusually presenting with no upper extremity signs and only lower extremity signs of progressive bilateral leg weakness and neurogenic urinary incontinence. This case emphasizes the importance of considering cervical spine workup in addition to thoracic and lumbar spine and conducting a comprehensive clinical neurological examination in the setting of lower extremity symptoms with progressive bilateral leg weakness and urinary incontinence.