An Illustrative Case of Cervical Spondylotic Myelopathy and Medullary Cavernoma: Which Should Be Treated First?

Cervical spondylotic myelopathy (CSM) and spinal cavernoma (SC) represent distinct yet challenging conditions. CSM manifests as progressive neurological dysfunction, whereas SC denotes a benign vascular lesion. The need for documented cases featuring CSM and SC highlights the absence of evidence-based management guidelines for such scenarios. CSM typically presents as a gradual neurological decline, predominantly afflicting middle-aged men. Pathophysiological mechanisms involve axonal stretching and ischemia. Classic symptoms encompass gait instability, bladder dysfunction, limb paresis, hyperreflexia, and somatic pain. Diagnostic complexities persist due to the weak correlation between radiological findings and clinical severity, complicating treatment decisions. In contrast, SC, although often asymptomatic, exhibits a preference for the thoracic and cervical segments and can mimic intramedullary tumors. Diagnosis typically relies on magnetic resonance imaging (MRI) due to the limitations of angiography. This case study of a 66-year-old male with concurrent CSM and SC sheds light on the diagnostic and treatment challenges encountered. Surgical intervention targeting CSM preceded SC resection, resulting in significant clinical improvement. In conclusion, managing patients with concurrent CSM and SC necessitates a tailored approach, considering each condition's distinct characteristics and treatment goals. Further research is warranted to establish standardized management algorithms for this complex clinical scenario.