Orthopaedic Case of the Month: A 62-year-old Woman With Neck Pain and Neurologic Findings

Abstract

A 62-year-old woman presented with 3 months of intractable neck pain with recent onset of upper extremity weakness and paresthesias. She reported no fever, weight loss, fatigue, or generalized malaise. She had subtle complaints of hand dexterity loss but said she had no problems with balance, and no bladder or bowel complaints. Analgesics and antispasmodic medications did not relieve her pain. Her medical history was significant for hypertension, hyperlipidemia, diabetes mellitus Type II, multiple sclerosis, depression, anxiety, obesity, and hypothyroidism. There was no history of antecedent trauma, previous rheumatologic phenomena, recurrent infections, or bleeding dyscrasia. There was no family history of cancer or congenital skeletal abnormalities. Review of systems was otherwise negative.On physical examination, the patient was afebrile with normal vital signs. She was oriented to person, time, and environment. The head was normocephalic and sclerae were anicteric. ROM of the neck was normal, and she had no pain with movement of her neck. She had no palpable lymphadenopathy. There was no tenderness to palpation of the posterior shoulder musculature. Cranial nerves II through XII were grossly intact; signs of hypocalcemia including Chvostek's sign and Trousseau's signs were not elicited. Abdominal examination was benign without hepatomegaly or splenomegaly. Neurologically, the patient had some mild weakness with wrist extension and finger extension on the left (C 4/5) but an otherwise normal examination with intact sensation and motor function in her lower extremities. Reflexes were brisk and symmetric. Hoffmann's sign was positive but symmetric suggesting an upper motor neuron lesion, but there was no elicitable clonus. Babinski response was plantar indicating a normal neurologic response in the lower extremities.Laboratory examination showed a white blood cell count of 7.8, hematocrit of 37.3, mean corpuscular volume (MCV) of 84, with a normal differential (54% segmented neutrophils, 9% band neutrophils, 33% lymphocytes), normal chemistries including a serum calcium of 8.9 mg/dL, and an erythrocyte sedimentation rate of 100 mm/hour.We obtained CT scans of the cervical spine (Fig. 1), head, and chest, abdomen, and pelvis, MR images of the spine (Fig. 2), and a whole-body bone scan. Imaging InterpretationThe CT scan of the cervical spine showed a prevertebral lesion extending from C7 to T2 and a permeative pattern of bone destruction within the C7 vertebra (Fig.

Acute Lymphoblastic Leukemia Presenting Initially as Spinal Cord Compression: When Chemotherapy Alone Is Enough

“…Astute recognition of acute leukemia as a cause of SCC is critical as the management may differ from the typical approach to SCC in patients with solid tumor malignancies. ere are only three cases reported in the literature of a previously healthy adult presenting with SCC in association with ALL [6][7][8]. e cases are summarized in Table 1.…”