Cervical Spondylosis as a Potential Cause of Venous Hypertensive Myelopathy: A Case Report

Am J Case Rep, 2023 · DOI: 10.12659/AJCR.942149 · Published: December 17, 2023

Neurology Spinal Disorders Research Methodology & Design

Simple Explanation

This case report discusses a rare instance where cervical spondylosis, a condition involving the degeneration of the cervical spine, may have led to venous hypertensive myelopathy (VHM). VHM is typically linked to spinal vascular malformations. The patient, a 74-year-old man, experienced a rapid decline in neurological function alongside unusual expansion in the spinal cord's high-signal intensity region, as observed on MRI. This expansion progressed towards the brainstem. The patient underwent surgery to decompress the spinal cord, which led to significant improvement in his neurological symptoms and the abnormal signals seen on MRI, suggesting that the spondylotic cord compression contributed to VHM.

Study Duration

Not specified

Participants

Male, 74-year-old

Evidence Level

Level 4; Case Report

Key Findings

1
The patient's symptoms and MRI results improved significantly after surgical decompression, suggesting that cervical spondylosis can indeed cause VHM.
2
The unusual expansion of the high-signal intensity area on the T2-weighted MRI, progressing to the pons, indicated an indirect compression injury to the spinal cord.
3
The hypothesis that spinal vein drainage disorders result in VHM is supported by several observations, including the high-signal intensity region exceeding the compression area and the correlation between posture and symptom severity.

Research Summary

This case report presents an uncommon instance of cervical spondylotic myelopathy (CSM) with rapid neurological deterioration and unusual growth of the high-signal intensity area on T2-weighted MRI, extending to the pons. The patient's symptoms, including pain, numbness, weakness, and bowel/bladder dysfunction, worsened despite hormone therapy, but improved significantly after posterior cervical laminoplasty and decompression surgeries. The findings suggest that spondylotic cord compression can lead to VHM, emphasizing the importance of accurate diagnosis and timely surgical intervention in similar clinical presentations.

Practical Implications

Differential Diagnosis

VHM should be considered in the differential diagnosis of patients presenting with symptoms similar to this case, especially when rapid neurological deterioration and unusual MRI findings are observed.

Surgical Intervention

Timely surgical decompression can be an effective treatment for VHM caused by spondylotic cord compression, leading to significant improvement in neurological function and imaging abnormalities.

Pathophysiology

The study highlights the potential role of venous drainage disorders in the development of VHM due to cervical spondylosis, which can lead to spinal cord edema, necrosis, and dysfunction.

Study Limitations

1
Single case report limits generalizability
2
Lumbar puncture was not performed
3
Further research is needed to confirm the causal relationship between cervical spondylosis and VHM

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