Laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy in an adult patient with osteopetrosis: a case report and literature review

Background: Osteopetrosis is a sclerosing bone disorder caused by defective bone resorption due to dysfunctional osteoclasts. A variety of orthopedic presentations have been described in autosomal dominant osteopetrosis patients. However, cases of multilevel cervical spondylotic myelopathy in osteopetrosis patients have been seldom discussed in the literature. The aim of this study was to present a case of cervical spondylotic myelopathy in association with osteopetrosis and to discuss its management. Case presentation: A 43-year-old man presented to our hospital with a 7-month history of progressive stiffness and numbness in the upper and lower extremities. Imaging findings, intraoperative pitfalls, and 4-year follow-up data are reported. The patient successfully underwent a posterior laminectomy and spinal fusion with instrumentation from C3 to C6. He had an uneventful postoperative recovery. At the 4-year follow-up, the Japanese Orthopaedic Association (JOA) score had increased from 10 to 14, and the patient had stable fixation with no evidence of implant migration or disruption. Conclusions: The occurrence of multilevel cervical spondylotic myelopathy in patients with osteopetrosis is rare. When surgery is required, laminectomy with posterior spinal fusion is indicated and reasonable. Intraoperative difficulties due to sclerosing and brittle bone should be anticipated.