Location
Philadelphia, PA
Start Date
17-4-2026 1:30 PM
End Date
17-4-2026 2:30 PM
Description
Background: Cervical spondylotic myelopathy (CSM) is a progressive condition that occurs due to degenerative changes of the spine that compress the spinal cord, leading to potential permanent neurological damage. It generally occurs in people over the age of 50 and has a wide range of clinical presentations with varying neurological symptoms. Because of its varied presentation, diagnosis is often delayed, resulting in increased morbidity.
Case Presentation: We present the case of a 69-year-old male referred to a pain management clinic by his primary care physician for evaluation of his significant neurological symptoms, including pain, weakness, gait disturbance, and reduced sensation. His primary complaint was progressive right upper extremity weakness that had worsened over several years, with a delay in seeking care attributed to his role as the primary caregiver for his spouse. MRI revealed multilevel cervical spinal cord compression with associated myelomalacia, most prominent at C4 - C7. The patient was subsequently referred for proper surgical intervention. Physical examination demonstrated variable muscle strength throughout the right upper extremity, highlighting the diagnostic importance of systematic neuromuscular assessment in suspected cervical myelopathy.
Discussion: This case highlights the need for clinicians to maintain a high index of suspicion for CSM, particularly in older patients with insidious, progressive neurological decline. The presence of myelomalacia indicates a less favorable surgical prognosis, reinforcing the importance of early recognition. Additionally, this case illustrates how caregiver burden can serve as a barrier to timely medical evaluation, especially in an older population. Early diagnosis and prompt surgical management are critical to preventing irreversible spinal cord damage.
Embargo Period
6-3-2026
Included in
Delayed presentation of cervical myelopathy diagnosed in a pain management clinic
Philadelphia, PA
Background: Cervical spondylotic myelopathy (CSM) is a progressive condition that occurs due to degenerative changes of the spine that compress the spinal cord, leading to potential permanent neurological damage. It generally occurs in people over the age of 50 and has a wide range of clinical presentations with varying neurological symptoms. Because of its varied presentation, diagnosis is often delayed, resulting in increased morbidity.
Case Presentation: We present the case of a 69-year-old male referred to a pain management clinic by his primary care physician for evaluation of his significant neurological symptoms, including pain, weakness, gait disturbance, and reduced sensation. His primary complaint was progressive right upper extremity weakness that had worsened over several years, with a delay in seeking care attributed to his role as the primary caregiver for his spouse. MRI revealed multilevel cervical spinal cord compression with associated myelomalacia, most prominent at C4 - C7. The patient was subsequently referred for proper surgical intervention. Physical examination demonstrated variable muscle strength throughout the right upper extremity, highlighting the diagnostic importance of systematic neuromuscular assessment in suspected cervical myelopathy.
Discussion: This case highlights the need for clinicians to maintain a high index of suspicion for CSM, particularly in older patients with insidious, progressive neurological decline. The presence of myelomalacia indicates a less favorable surgical prognosis, reinforcing the importance of early recognition. Additionally, this case illustrates how caregiver burden can serve as a barrier to timely medical evaluation, especially in an older population. Early diagnosis and prompt surgical management are critical to preventing irreversible spinal cord damage.