Robles Luis A, Chakravarthy Vikram
Neurosurgery, CMQ Premiere Hospital, Puerto Vallarta, MEX.
Neurosurgery, Cleveland Clinic Foundation, Cleveland, USA.
Cureus. 2021 Jan 6;13(1):e12523. doi: 10.7759/cureus.12523.
Cervical spondylotic myelopathy (CSM) and amyotrophic lateral sclerosis (ALS) share some clinical findings. Hence, motor neuron disease (MND) should be considered in the differential diagnosis of patients presenting with signs and symptoms of CSM. This unique case demonstrates the coexistence of both conditions in the same patient. The author reports the case of a 74-year-old male who initially underwent posterior cervical decompression and instrumented fusion for cervical myelopathy. He demonstrated postoperative improvement followed subsequently by unexplained neurological deterioration. A repeat MRI showed adequate decompression of the cervical cord and persistence of T2 hyperintense signal in the spinal cord. Based on the presence of signs and symptoms of lower motor neuron disease, electromyography (EMG) was performed demonstrating findings of MND. The presence of MND in a patient with CSM is unique and can be difficult to diagnose based on overlapping symptoms. This case highlights the importance of EMG and the vigilance that spine surgeons need to display to identify ALS or other MND, despite the presence of ongoing cervical myelopathy. In cases where patients show discordant symptoms, further studies should be performed.
脊髓型颈椎病（CSM）和肌萎缩侧索硬化症（ALS）有一些共同的临床表现。因此，在对出现CSM体征和症状的患者进行鉴别诊断时，应考虑运动神经元病（MND）。这个独特的病例展示了这两种疾病在同一患者身上共存的情况。作者报告了一例74岁男性患者，该患者最初因颈椎病接受了颈椎后路减压及内固定融合手术。术后他的病情有所改善，但随后出现了无法解释的神经功能恶化。再次进行的磁共振成像（MRI）显示颈髓减压充分，但脊髓内T2高信号持续存在。基于下运动神经元病的体征和症状，进行了肌电图（EMG）检查，结果显示为MND。CSM患者中出现MND的情况很独特，基于症状重叠可能难以诊断。该病例突出了EMG的重要性，以及脊柱外科医生在识别ALS或其他MND时所需保持的警惕性，尽管患者同时存在颈椎病。对于出现不一致症状的患者，应进行进一步检查。
