Cervical Myelopathy Associated With Deep Neck Muscle Rhabdomyolysis After Polysubstance Abuse: A Case Report

Rhabdomyolysis is a potentially life-threatening syndrome caused by skeletal muscle breakdown and the release of intracellular contents into circulation, often resulting in complications such as acute kidney injury. Although it most commonly affects the limbs, rhabdomyolysis of the deep neck muscles is rare and can lead to secondary cervical myelopathy. Recent reports have highlighted a strong association with polysubstance abuse, particularly combinations of opioids with sedatives such as benzodiazepines or pregabalin. We describe a 41-year-old female patient who developed acute quadriparesis following polysubstance use involving pregabalin, methamphetamine, buprenorphine, and alcohol. MRI revealed a longitudinal T2-hyperintense cervical cord lesion from C2 to T3 with marked paravertebral muscle edema, consistent with deep neck muscle rhabdomyolysis. Laboratory findings showed a creatine phosphokinase peak of 16,093 U/L, which normalized with corticosteroid therapy and intravenous hydration. Despite normalization of laboratory values, the patient had persistent limb weakness at discharge due to venous hypertensive myelopathy, inadvertently caused by deep cervical rhabdomyolysis. This case reinforces emerging evidence that deep cervical muscle rhabdomyolysis can lead to venous hypertensive myelopathy through a compartment-syndrome-like mechanism. Awareness of this presentation is essential, as early MRI of both the spinal cord and paravertebral musculature may enable timely diagnosis and improved outcomes in polysubstance-related myelopathy.