Title : Progressive myelopathy in a 51yo F due to cervical spondylosis
Abstract:
At an Emergency Room visit due to a fall in August 2025, she noted numbness initially in her pinky toe in April 2025, has now progressed in the entire right lower extremity, and as well as to the left lower extremity and both fingers. Formal strength testing of limbs was not recorded. Pt was ruled out for CVA. In an Emergency Room visit in September 2025 for another fall, she reported ongoing lower extremity numbness and having anesthesia to her perineum for the prior 3 mos. Weakness in all extremities noted in history, however, strength for all extremities was noted 5/5. A lumbar MRI was ordered at time of this September 2025 ER visit. A third ER visit was in Dec 2025 for worsening heaviness of right lower extremity and bilateral low back pain, denying fecal and urinary incontinence. MSK strength testing was not noted in this encounter. Her oral pain medications were refilled and a wheeled walker was provided at discharge from the ER.
The Lumbar MRI noted degenerative disc and facet disease. Moderate central canal stenosis of L4-L5, with foraminal narrowing to mild-moderate in L5-S1. MRI findings noted not to match her symptoms. Along with an Ortho Spine consult, she was given a prescription for Gabapentin and a Medrol steroid dose pack. A bilateral lower extremity EMG/NCS performed in March 2026 had shown evidence of peripheral neuropathy without showing evidence of radiculopathy, plexopathy, myelopathy. The PM&R physician ordered a Head, Cervical & Thoracic MRI. The Cervical MRI was significant for severe canal stenosis at C4/5 of only a 2mm AP distance.
At time of presentation to the PM&R pain clinic on 7/24/26 and with prior encounters, she had denied cervical pain. However, in the past 4 to 6 mos, she reported developing progressive bilateral upper extremity weakness, along with changes in bowel and bladder patterns consistent with upper motor neuron lesions. She was promptly referred for neurosurgical evaluation. At time of this report, the patient was placed on bed rest and scheduled for surgery on 8/21/26 for a C4-7 ACDF.
