Physiatrist Mercy Fitzgerald Hospital Darby, Pennsylvania, United States
Case Diagnosis: Cervical myelopathy
Case Description: A 65-year-old male patient was admitted for 1 week of lower extremity weakness. Reflexes were diminished throughout. MRI of the spine was significant for degenerative disc disease at C3-4 and C5-6, with no other evidence for cord compression. Patient was admitted to ARU for ataxia and multifactorial peripheral neuropathy (DM, ESRD, ETOH abuse, PVD, cervical spondylosis, and old lacunar infarct). Initially, the patient was MinA with RW ambulating 30’. Four days into his therapy, the patient suddenly worsened, requiring MaxA for ambulation, with worsened spasms and burning pain in upper extremities. Repeat dedicated cervical spine MRI showed moderate-severe spinal stenosis and cord compression at C3-4 and severe foraminal stenosis at C4 and C6. Subsequently, patient underwent C3-C6 laminectomy for myelopathy. Post operation, the patient immediately progressed to ModA ambulation with RW and had resolution of spasms and burning pain. Patient was discharged to sub-acute rehabilitation.
Discussions: Cervical spondylosis is a very common diagnosis and neck pain is one of the leading causes of disability. Common rehabilitation diagnoses such as stroke, amputations, hip and knee replacements, SCI, and trauma require patients to compensate and heavily rely on their upper body for function and ambulation. This case highlights that rehabilitation patients with comorbidities of cervical spondylosis may be at risk of cervical myelopathy due to sustained stress of the spine as they undergo physical therapy for another rehab diagnosis.
Conclusions: This case warrants the discussion to consider cervical precautions in patients with underlying cervical spondylosis when undergoing rehabilitation for their primary diagnosis. These precautions are typically used in patients with acute spinal injury, however it should be investigated if a version of these precautions can be used to prevent injury in patients who are susceptible to further injury as they undergo therapy.