Hidden coexisting pathology diagnosed after cervical surgery in patients with degenerative cervical myelopathy or myeloradiculopathy: A case series report. (November 2021)

• Record Type: Journal Article
• Authors: Sumikawa, Minako; Yano, Toma; Mizutani, Masahiro; Fujishiro, Takashi; Nakaya, Yoshiharu; Hayama, Sachio; Nakano, Atsushi; Fujiwara, Kenta; Neo, Masashi
• Is Part Of: Journal of clinical neuroscience. Volume 93(2021)
• Page Start: 253
• Page End: 258
• Publication Date: 2021-11
• Subjects: Degenerative cervical myelopathy -- Cervical spondylotic myelopathy -- Myeloradiculopathy -- Differential diagnosis -- Misdiagnosis -- Amyotrophic lateral sclerosis -- Polymyalgia rheumatica; ALS amyotrophic lateral sclerosis -- CLP cervical laminoplasty -- CRP C-reactive protein -- CT computed tomography -- CTS carpal tunnel syndrome -- DCM degenerative cervical myelopathy -- DCMR degenerative cervical myeloradiculopathy -- DTR deep tendon reflex -- MRI magnetic resonance imaging -- MS multiple sclerosis -- PMR polymyalgia rheumatic -- TB tuberculosis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.05.053
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Degenerative cervical myelopathy (DCM) or myeloradiculopathy (DCMR) may coexist with other pathologies that mimic a part of its clinical manifestations. This is a case series, wherein patients in whom such pathologies were overlooked preoperatively were reviewed. The coexisting pathology with DCM or DCMR was identified in three cases (1.3%) in an academic centre cohort. The coexisting diseases identified were diverse and did not only consist of neurological disorders. Abstract: Many neurological disorders can present similar symptomatology to degenerative cervical myelopathy (DCM) or myeloradiculopathy (DCMR). Therefore, to avoid misdiagnosis, it is important to recognise the differential diagnosis, which has been well described in previous literature. Additionally, DCM or DCMR can also coexist with other diseases that overlap some of its clinical manifestations, which may be overlooked before cervical surgery. Nevertheless, few studies have addressed this clinical situation. In clinical practice, the diagnosis of coexisting disease with DCM or DCMR would be typically made when some symptoms persist without improvement after cervical surgery. To inform the patients of this possibility preoperatively and arrive at the early diagnosis during the postoperative period, some knowledge of the possible coexisting diseases would be necessary. In this report, we reviewed 230 patients who underwent surgery for DCM or DCMR in an academic centre to examine the prevalence and kind of underlying disease that was overlooked preoperatively. The coexisting diseases relevant to their baseline symptoms were diagnosed only after cervical surgery in three patients (1.3%) and included amyotrophic lateral sclerosis, lung cancer and polymyalgia rheumatica. The overlapping symptoms were gait difficulty, scapular pain and neck pain, respectively. Surgeons should recognise that the coexisting disease with DCM or DCMR may be overlooked before cervical surgery because of overlapping symptomatology, although its prevalence is not certainly high. Further, when the specific symptom persisted without improvement after surgery for DCM or DCMR, the patient should be comprehensively examined, considering diverse pathological conditions, not only neurological disorders.