Cervical Spinal Cord Compression With Myelopathy

This 52 year-old female presents with 4 months of progressive neck pain, numbness of both hands, and difficulty using her hands and buttoning a shirt. She was noted to have mild right-sided weakness in a long track distribution which included her finger extensor, hip flexor, dorsiflexor weakness.  She had tried chiropractic care.  Imaging revealed a very large C4-5 disc herniation with severe cord compression which was more eccentric to the right, but also causing left-sided compression (Fig 1). The patient also had C5-6 disc collapse with biomechanical reduction of the C5-6 motion segment which puts more stress on the next segment. In essence the C5-6 is acting like it is autofused. This resulted in premature degeneration of the C4-5 segment which resulted in the disc herniation.  It was decided, given a diagnosis of early cervical myelopathy with spinal cord compression, to offer an anterior cervical discectomy and fusion at C4-5 to decompress the spinal cord.