Cervical spondylosis with propriospinal myoclonus and vocalization: a case report

Cervical spondylosis typically presents with neck pain, radiculopathy, or myelopathy, but rarely with spinal myoclonus. Propriospinal myoclonus (PSM)-characterized by involuntary trunk and limb jerks-is an exceedingly rare manifestation of cervical spondylosis, with limited reports of associated vocalizations.

A 55-year-old man presented with a 3-year history of neck pain, which progressed to dizziness, lower limb weakness, and intermittent propriospinal myoclonus manifesting as hand tremors and involuntary vocalizations. Cervical MRI and CT revealed C3/4-C5/6 disc protrusion, C5 instability, and spinal cord compression. Initial conservative treatments were ineffective. Endoscopic anterior cervical decompression and fusion (C3-C6) was performed, removing protruding discs and relieving spinal cord compression. Postoperatively, myoclonus and vocalizations resolved within 24 h, with improved lower limb strength and gait stability (mJOA: 12 → 18). Imaging confirmed restored cervical lordosis and implant stability. No recurrence was observed at 12-month follow-up.

This rare case of cervical spondylosis presenting with PSM and vocalizations highlights the diagnostic challenge of distinguishing spinal myoclonus from epilepsy or psychogenic disorders. Endoscopic anterior cervical decompression effectively alleviated symptoms, suggesting a compressive etiology. Clinicians should consider spinal myoclonus in atypical presentations of cervical spondylosis, and early surgical intervention may be warranted in refractory cases. This report underscores the role of comprehensive imaging and multidisciplinary evaluation in managing complex spinal disorders.