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Multiple sclerosis diagnosis after anterior cervical discectomy and fusion
EANS Academy. MacCormick A. 09/25/19; 275307; EP02040
Dr. Andrew MacCormick
Dr. Andrew MacCormick

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Introduction: Many of the clinical manifestations of cervical myelopathy may mimic other neurological disorders and due to this, it is often only diagnosed when the disease has significantly progressed. We present a unique case of a patient who had clinical manifestations and multiple resonance imaging (MRI) findings of cervical myelopathy, however had an eventual diagnosis of multiple sclerosis.
Case report: A 41-year-old male presented to clinic after musical colleagues noted his guitar playing ability had reduced over the past nine months. He noted numbness affecting the hands and feet bilaterally and developed persistent tiredness and weakness affecting all four limbs. No history of poor balance, unsteadiness or dropping objects, however he had reduced exercise tolerance. MRI scan-central posterior cord bulge at the C3/C4 level with disc partially indenting the cord and a large posterior disc osteophyte complex at C4/C5 level which was compressing the cord. Associated intrinsic signalling consistent with cervical myelopathy. CSF replacement and cord signals were also demonstrated with associated myelomalacia. A subsequent diagnosis of C3/C4 and C4/C5 severe cervical canal stenosis with spinal compressive myelopathy.
Patient underwent C3/C4 and C4/C5 ACDF with no intra-operative or early post-operative complications. Patient reported an improvement in symptoms post operatively.
Patient then had two admissions in the following months with worsening symptoms in the arms and legs. MRI scan confirmed evidence of transverse myelitis and patient was placed on IV steroid therapy for 3 days. Lumbar puncture demonstrated presence of oligo-clonal bands and following specialist referral, a diagnosis of spinal multiple sclerosis was made using the generic Poser criteria.
Conclusion: If patient has early recurrence of myelopathic symptoms following ACDF, we feel that it is of paramount importance that once extrinsic cord complication factors have been excluded, surgeons should consider intrinsic cord pathologies so early neurological referral can be facilitated.
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