Ross Michael D, Elliott Ryan
U.S. Air Force Physical Training Program, Fort Sam Houston, Texas 78108, USA.
J Spinal Cord Med. 2010;33(4):431-4. doi: 10.1080/10790268.2010.11689724.
Diagnosing patients with cervical cord compressive myelopathy in a timely manner can be challenging due to varying clinical presentations, the absence of pathognomonic findings, and symptoms that are usually insidious in nature.
To describe the clinical course of a patient with primary complaint of left medial knee pain that was nonresponsive to surgical and conservative measures; the patient was subsequently diagnosed with cervical cord compressive myelopathy.
Case report.
A 63-year-old man with a primary complaint of left medial knee pain.
Physical examination of the left knee was normal except for slight palpable tenderness over the medial joint line. During treatment, he noted loss of balance during activities of daily living. Reassessment revealed bilateral upper extremity hyperreflexia, bilateral Babinski reflex, and positive bilateral Hoffman reflex. Magnetic resonance imaging of the cervical spine demonstrated moderately severe spinal stenosis at the C3-C4, C5-C6, and C6-C7 levels. After C3-C7 laminoplasty for cervical cord compressive myelopathy, he reported substantial improvement of his left medial knee. Three years later, he had no complaint of knee pain.
Appropriate diagnosis and treatment of cervical cord compressive myelopathy may avoid unnecessary diagnostic imaging, medical evaluations, invasive procedures, and potential neurologic complications.
由于临床表现各异、缺乏特异性体征且症状通常隐匿，及时诊断颈髓压迫性脊髓病患者具有挑战性。
描述一名以左膝内侧疼痛为主诉的患者的临床病程，该患者对手术和保守治疗均无反应；随后被诊断为颈髓压迫性脊髓病。
病例报告。
一名63岁男性，以左膝内侧疼痛为主诉。
左膝体格检查正常，仅在内侧关节线处有轻微压痛。治疗期间，他注意到日常生活活动中失去平衡。重新评估发现双侧上肢反射亢进、双侧巴氏征阳性和双侧霍夫曼征阳性。颈椎磁共振成像显示C3 - C4、C5 - C6和C6 - C7水平存在中度严重的椎管狭窄。在进行颈髓压迫性脊髓病的C3 - C7椎板成形术后，他报告左膝内侧疼痛有显著改善。三年后，他没有膝关节疼痛的主诉。
颈髓压迫性脊髓病的正确诊断和治疗可避免不必要的诊断性影像学检查、医学评估、侵入性操作及潜在的神经并发症。
