Dyspnea as the Presenting Symptom of Cervical Spondylotic Myelopathy

Abstract

Background A case report of acute unilateral hemidiaphragm paralysis and resultant dyspnea due to cervical spondylotic myelopathy (CSM) is described. Case Report An 82-year-old man presented with a nonproductive cough, chest congestion, hoarseness, and shortness of breath on ambulation. The patient underwent cardiac catheterization, which revealed extensive stenosis of the major cardiac arteries. Subsequently, he underwent triple coronary artery bypass grafting. Despite the cardiac surgery, the patient's dyspnea did not improve. In addition, he developed new complaints of generalized weakness. Magnetic resonance and radiographic imaging of the cervical spine revealed extensive multilevel degenerative spondylosis with moderate to severe central canal narrowing from C2 to C7 and myelomalacia. The patient underwent C2–C6 laminectomy and instrumented fusion with local autograft. After surgery, the patient had gradual relief of dyspnea as well as improvement of strength. The dyspnea completely resolved. Conclusion The diagnosis of CSM as the cause of dyspnea is difficult to make. When unrelated cardiac or pulmonary disease coexists, the presenting symptoms of CSM may be subtle and must be actively sought. Signs and symptoms can vary widely and may include symptoms of intermittent neck pain or headache. Dyspnea may be related to unilateral diaphragm paralysis caused by CSM. This etiology of dyspnea should be considered in elderly patients who have other comorbidities that often obscure the diagnosis.

[Retracted] Characterization of Clinical Symptoms of Cervical Spondylotic Myelopathy Based on DKI Imaging Parameter Ratios

“…After the operation, the patient's dyspnea gradually eased and his physical strength also improved, and the dyspnea was completely relieved. Dyspnea may be related to unilateral diaphragmatic paralysis caused by CSM, and there is a lack of research on the multiple populations of the disease in the overall research content [ 4 ]. A major drawback of CSM management is the dearth of validated methods of diagnosis to tier treatment and forecast outcomes.…”

Dyspnea Associated with Cervical Spondylotic Radiculopathy: A Case Report and Review of Literatures

“…Dyspnea is an extremely rare symptom in cervical spondylosis, making it difficult to diagnose alone. To our best knowledge, only 10 cases of phrenic nerve palsy associated with cervical spondylotic radiculopathy exist, including the present case [2][3][4][5][6][7][8][9][10] (Table 1), with nearly the same number of case reports associated with cervical myelopathy, [11][12][13][14][15][16][17][18][19] and some case series showed a declined respiratory function in cervical myelopathy. 20,21) Diagnosis of dyspnea associated with cervical spondylotic myelopathy is relatively straightforward because canal stenosis is easy to be recognized on radiological…”

Cervical Spine Stenosis Causing Diaphragmatic Paralysis: A Case Study and Narrative Review of Clinical Presentations and Outcomes

“…Only articles that documented radiologic evidence of myelopathy or radiculopathy were included. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Across the cases, the average age was 64 years old, with 16 male and 3 female patients (Table 2). The most common etiology (n = 6, 32%) involved cervical trauma from a motor vehicle accident, lifting heavy objects, and iatrogenic injury.…”