Decoding unusual MR findings: Spinal cord edema in atypical cervical spondylotic myelopathy-A case report and literature review.

ABSTRACT

We report a case of a young man with a slow progression of cervical spondylotic myelopathy (CSM). Cervical magnetic resonance imaging (MRI) revealed a mild cervical discbulging at C5-C6 and an area of atypically enlarged intramedullary high signal intensity extending from C4-C7 (T2-weighted) with contrast enhancement at C5-C6 (T1-weighted). Neurological and radiological diagnoses tend to favor demyelinating diseases, which interfere with the diagnosis of CSM. Patients were followed up and examined by MRI at 3 months, 1 year, and 2 years after surgery. The patient's symptoms improved immediately postoperatively. The functional result according to the modified Japanese Orthopedic Association (JOA) score improved from 10 to 13 within 3 months. He continued to improve neurologically over the first postoperative year. Two years postoperatively, a T2-weighted MRI showed that the edema signal had disappeared completely, and a fat-saturated T2-weighted MRI showed only slight abnormal signal. The numbness and weakness of the extremities had improved, and his JOA score was 16. Spinal cord edema is occasionally seen with CSM. In the case presented, the contrast enhancement was localized at the site of the greatest narrowing of the spinal canal and compression of the spinal cord. This coincidence was the best indicator of a mechanical cause of the spinal cord changes. This feature should increase physician's confidence in distinguishing CSM from intramedullary tumors and myelitis. Surgical decompression may be beneficial in improving neurologic outcomes.