1102 - From Rehab to the OR: Recognition of Cervical Cord Compression in a Polytrauma Patient

Cervical spinal cord compression in the setting of traumatic brain injury and rib fractures was discovered during inpatient rehabilitation.

Case Description: A 65-year-old male fell down stairs, sustaining an extra-axial hemorrhage, subarachnoid hemorrhage, and nondisplaced rib fractures. Initial cervical spine CT was unremarkable. While in acute care, he noted right upper extremity weakness, initially attributed to shoulder pathology; X-ray showed calcific tendinitis. Ten days later, he was admitted to inpatient rehabilitation. He reported severe stabbing neck pain radiating to the right shoulder. Strength examination revealed right shoulder flexion/abduction 1/5 and elbow flexion/extension 3/5, with orthostatic hypotension. MRI revealed severe spinal canal stenosis and spinal cord compression at C5–C6. He was readmitted to acute care and underwent posterior spinal fusion (C2–T2) with C3–C7 laminectomies, followed by anterior cervical discectomy and fusion at C5–C6. Postoperatively, his pain and neurologic function improved.

Discussions: Differentiating cervical cord pathology from peripheral musculoskeletal causes can be clinically challenging, as weakness and pain may overlap. In this patient, initial right upper extremity weakness was attributed to shoulder pathology. However, persistent and progressive motor deficits during rehabilitation warranted further evaluation with MRI, leading to a timely diagnosis and surgical intervention that prevented further neurologic decline. This case highlights the importance of careful, ongoing neurologic assessment in rehabilitation settings and maintaining a high index of suspicion for spinal pathology when exam findings change.

Conclusions: Inpatient rehabilitation remains a vital setting not only for functional recovery but also for ongoing medical assessment. Even when neurologic deficits are apparent during acute hospitalization, careful evaluation in rehabilitation can clarify the underlying cause, prompt further workup, and ensure timely intervention. Physiatrists play a critical role in identifying deficits that may be misattributed to other injuries, and early recognition, along with acute care transfer, can significantly improve patient outcomes.