Medical Student University of Kansas School of Medicine
Introduction: Spinal cord sarcoidosis (neurosarcoidosis) can offer diverse clinical and radiographic presentations. Though rare, practitioners may misdiagnose neurosarcoidosis as cervical spondylotic myelopathy (CSM), a more common neurosurgical pathology, even with extensive differentials, consultations, and imaging. Patient outcomes depend on neurosurgeons’ ability to distinguish these entities. Here the authors provide a review of literature on neurosarcoidosis mimicking CSM.
Methods: The authors conducted a systematic literature review through the PubMed database with keywords “sarcoid”, “cervical”, and “myelopathy” to identify case reports of patients presenting with myelopathic symptoms due to neurosarcoidosis. The authors reviewed all articles discussing patients with presumed cervical spondylotic myelopathy (CSM) treated surgically with decompression but later diagnosed with neurosarcoidosis.
Results: The authors searched PubMed and identified 83 candidate articles. Five met inclusion criteria. Nine total patients were reviewed. Fifty-five percent were male with a mean age of 57 ± 11.5 years (range 29-69 years). All patients underwent surgical decompression for a presumed diagnosis of CSM. Post-operative course led to subsequent neurologic decline within average of 1.4 ± 1.7 months (range 0-5 months) after surgery. Neurosarcoidosis was diagnosed with further testing and steroids or immunosuppressant therapy was initiated with variable improvement.
Conclusion : Neurosarcoidosis is an important differential diagnosis when considering etiologies of CSM and requires a high degree of suspicion. In patients with suspected findings, early diagnosis and treatment may prevent avoidable surgery, reduce complications, and improve outcomes.
How to Improve Patient Care: If neurosarcoidosis is caught early then invasive surgery can be avoided. Diagnosis requires a high degree of suspicion by the neurosurgeon. Early diagnosis and medical treatment with steroids or biologic therapies may prevent deleterious surgical interventions and associated complications. A thorough history and systemic evaluation is therefore invaluable in these patients.
