Degenerative Cervical Myelopathy in a Patient With a Pre-existing Cervical Spinal Cord Stimulator: A Case Report.

Degenerative cervical myelopathy (DCM) is a progressive condition that can lead to significant neurologic disability if not promptly diagnosed and treated. The presence of a neuromodulation device in the spinal canal, such as a spinal cord stimulator (SCS), can potentially hinder the diagnosis and management of DCM. Here, we report a case of a 53-year-old female patient with a history of complex regional pain syndrome being managed with a cervical SCS, who presented with DCM and rapid neurological deterioration and bilateral lower extremity paralysis. The diagnostic workup was rendered more challenging due to contraindications for MRI related to the implanted SCS. CT myelogram demonstrated multilevel cervical stenosis with cord compression; the cervical leads were believed to contribute to the central stenosis. The patient underwent anterior cervical discectomy and fusion (ACDF) from C4 to C7, resulting in immediate improvement in her motor function and an uncomplicated postoperative course. At discharge, she had regained full strength in the lower extremities. This case highlights the unique diagnostic and management challenges of DCM in patients with pre-existing cervical neuromodulation devices. A high index of suspicion and timely use of alternative imaging modalities were essential for achieving favorable outcomes in this complex patient. Further research is needed to establish evidence-based recommendations for the management of DCM in the setting of neuromodulation devices.