1115 - From Numbness to Neurosurgery: Delayed Diagnosis of Cervical Myelopathy due to Multilevel Spondylosis - a Case Report

A 60-year-old female presented with progressive bilateral lower extremity weakness, left foot drop, paresthesias, and sensory loss below the neck over a 10-month period. Her symptoms progressively worsened, and she presented multiple times to an outpatient neurologist who was concerned for motor neuron disease versus cervical stenosis. An initial EMG/NCS was performed, and a repeat EMG was pending, contributing to a prolonged delay in definitive diagnosis. She was later evaluated by a physiatrist, who recommended urgent evaluation in the emergency department for advanced imaging. Upon hospital assessment, cervical spine MRI revealed multilevel spondylosis with cord compression at C5–C6, establishing the diagnosis. Brain MRI was unremarkable. The patient underwent anterior cervical discectomy and fusion (C4–C6) and was subsequently transferred to inpatient rehabilitation for functional recovery and mobility restoration.

Discussions: This case highlights the challenges and consequences of delayed diagnosis in cervical myelopathy. Despite nearly a year of progressive neurologic deficits, definitive identification of cord compression was postponed due to reliance on outpatient assessments and pending EMG studies. Timely MRI and a complete neurologic workup were critical in revealing the underlying structural pathology and guiding surgical intervention. Early and comprehensive evaluation is essential in patients with progressive weakness, sensory deficits, or foot drop to prevent irreversible neurologic decline.

Conclusions: Delayed diagnosis of cervical myelopathy can result in prolonged neurologic impairment. Persistent neurologic symptoms warrant prompt, comprehensive imaging and full neurologic workup to ensure timely diagnosis. Early identification, surgical intervention, and structured inpatient rehabilitation are crucial to halt disease progression and optimize functional recovery.