Atypical cervical spondylotic myelopathy mimicking intramedullary tumor

Study Design. Case report and a review of the literature. Objective. We report the case of a young man with a short course of progressive cervical myelopathy (CM). Cervical magnetic resonance imaging (MRI) revealed a stenosis of the cervical spinal canal at C4-C6 and an atypically enlarged intramedullary high intensity extending from C1-T1 (T2-weighted) with contrast enhancement at C4-C5 (T1-weighted). Neurologic and radiologic diagnosis therefore favored a tumor of the spinal cord. Summary of Background Data. CM is a clinical diagnosis of mostly degenerative origin in older patients that features circumscribed high-intensity signals near the point of compression in T2-weighted MRI. Contrast enhancement in those high-intense areas is rarely described in the literature, and the differentiation from neoplastic and infective lesions might be very difficult in these cases. Methods. Retrospective case study with follow-up examination and MRI-control 3 months after surgery. Results. The patient was decompressed and stabilized from dorsally, and a biopsy was taken. The exact diagnosis of a myelopathy and an exclusion of a neoplastic origin succeeded through histopathological examination. Three months after first surgery, the patient had improved significantly and underwent an additional anterior stabilization, while the MRI remained almost unchanged. Conclusion. In case of a fast progressive CM with atypical radiographic appearance initial decompression with inspection of the spinal cord and a short-term clinical followup with an MRI control might be the procedure of choice, if a clear diagnosis for a causative treatment cannot be made. In still suspicious cases, a biopsy could be considered to exclude a neoplastic or inflammatory process.