Giant cervical facet joint osteophyte causing myelopathy: illustrative case

Cervical spondylosis frequently leads to osteophyte formation to stabilize degenerative spinal segments. While osteophytes presenting with cervical myelopathy typically arise from the vertebral body, a cervical facet joint osteophyte causing spinal cord compression has not been described.

This report details the case of a 57-year-old right-handed male waiter with progressive myelopathy. Imaging confirmed a 2-cm calcified extradural mass at the C5 level causing significant spinal cord compression. Surgery revealed a giant osteophyte originating from the right C5-6 facet joint that was compressing the thecal sac and exiting nerve roots, which was subsequently resected. The patient experienced significant recovery postoperatively, with improved strength, balance, and resolution of sensory deficits.

To the authors' knowledge, this is the first description of a cervical facet joint osteophyte presenting with cervical myelopathy. This case highlights the variability of cervical degenerative disease. The proposed mechanism suggests that asymmetric joint stress resulting from his occupation with the right arm elevated initiated a cycle of facet degeneration and medial osteophyte proliferation, progressively occluding the central canal and causing myelopathy. https://thejns.org/doi/10.3171/CASE25987.