Motor Neuron Disease in a Patient With Cervical Spondylotic Myelopathy: Too Much Bad Luck

Abstract

Cervical spondylotic myelopathy (CSM) and amyotrophic lateral sclerosis (ALS) share some clinical findings. Hence, motor neuron disease (MND) should be considered in the differential diagnosis of patients presenting with signs and symptoms of CSM. This unique case demonstrates the coexistence of both conditions in the same patient. The author reports the case of a 74-year-old male who initially underwent posterior cervical decompression and instrumented fusion for cervical myelopathy. He demonstrated postoperative improvement followed subsequently by unexplained neurological deterioration. A repeat MRI showed adequate decompression of the cervical cord and persistence of T2 hyperintense signal in the spinal cord. Based on the presence of signs and symptoms of lower motor neuron disease, electromyography (EMG) was performed demonstrating findings of MND. The presence of MND in a patient with CSM is unique and can be difficult to diagnose based on overlapping symptoms. This case highlights the importance of EMG and the vigilance that spine surgeons need to display to identify ALS or other MND, despite the presence of ongoing cervical myelopathy. In cases where patients show discordant symptoms, further studies should be performed.

Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)

“…It was shown through a special case study that both diseases coexisted in the same patient. 26 Reduced hand dexterity, unstable gait, and sensory and motor dysfunction are among the classic signs of CSM. When a patient has a suspicion of CSM, magnetic resonance imaging is the preferred imaging modality; however, those who are not eligible for it may use computed tomography myelography.…”

Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)

“…It was shown through a special case study that both diseases coexisted in the same patient. 26 Reduced hand dexterity, unstable gait, and sensory and motor dysfunction are among the classic signs of CSM. When a patient has a suspicion of CSM, magnetic resonance imaging is the preferred imaging modality; however, those who are not eligible for it may use computed tomography myelography.…”

Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)

“…It was shown through a special case study that both diseases coexisted in the same patient. 26 Reduced hand dexterity, unstable gait, and sensory and motor dysfunction are among the classic signs of CSM. When a patient has a suspicion of CSM, magnetic resonance imaging is the preferred imaging modality; however, those who are not eligible for it may use computed tomography myelography.…”

Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)

“…It was shown through a special case study that both diseases coexisted in the same patient. 26 Reduced hand dexterity, unstable gait, and sensory and motor dysfunction are among the classic signs of CSM. When a patient has a suspicion of CSM, magnetic resonance imaging is the preferred imaging modality; however, those who are not eligible for it may use computed tomography myelography.…”