517 - Uncontrolled Spasticity Following Cervical Fusion: Unmasking Residual Cord Compression

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

NP

Nikit Patel, DO

Resident Physician
Jefferson Moss-Magee Rehabilitation
Philadelphia, Pennsylvania, United States

Co-Author(s)

SG

Surya Gourneni, MD

Resident Physician
Moss Rehab
Elkins Park, Pennsylvania, United States
DH

David Hopkins, MD

Resident Physician
Jefferson Moss Magee Rehabilitation
Philadelphia, Pennsylvania, United States

Submitter(s)

NP

Nikit Patel, DO

Jefferson Moss-Magee Rehabilitation
Philadelphia, Pennsylvania, United States

Case Diagnosis: Persistent cervical spinal cord compression presenting as uncontrolled spasticity following C3-C4 anterior cervical discectomy and fusion (ACDF).

Case Description: A 74-year-old male with cervical myelopathy and multiple co-morbidities presented to inpatient rehabilitation hospital (IRH) following C3-C4 ACDF. On arrival, he reported bilateral lower extremity spasms previously managed with tizanidine 2mg q8hr PRN. Baclofen 5mg q8hr was started on day 1 and titrated to 15mg q8hr by day 4 for persistent spasticity affecting sleep and therapy. Despite increasing tizanidine to 4mg q8hr PRN and adding cyclobenzaprine 5mg q8hr, spasms remained uncontrolled. Cervical-spine MRI revealed C1-C4 severe canal stenosis, persistent cord compression, and 5mm anterolisthesis at C3-C4. He was transferred to acute care and underwent C3-C5 posterior cervical fusion and decompression, and C2-C5 posterior fusion. He returned to IRH on cyclobenzaprine. On re-admission day 3, baclofen 5mg q8hr was resumed with nighttime dose gradually up-titrated to 15mg by day 15. His spasticity improved, allowing full participation in therapy. By discharge, spasms were well controlled on baclofen 5/5/15mg and cyclobenzaprine 5mg q8hr.

Discussions: Symptomatic cervical myelopathy oftentimes presents with upper extremity symptoms; however, lower extremity spasticity also can occur¹. Pharmacological management is commonly used to provide relief for spasticity. However, persistent or worsening spasticity may indicate other etiologies and not solely reflect inadequate treatment. One study showed that 40% of cervical myelopathy patients had post-operative MRI findings with cord compression². It is imperative to obtain timely imaging to guide further management.

Conclusions: This case highlights that close monitoring of spasticity in post-operative cervical myelopathy patients is essential in inpatient rehabilitation. Persistent or worsening symptoms should prompt timely evaluation for residual cord compression.