Clinical Course
This 70 year old patient developed numbing, burning, aching in both arms over a 2 month period with progressive interference in her quality of life. She did not have difficulty walking but neck motion (especially looking up) caused the burning radiation into the arms. Her physical exam did not reveal significant deficits due to the early course of her symptoms except for immediate numbness with extension of her head and an electric shcok like feeling radiating down both arms and into the chest.

Diagnostic Tests
A cervcial MRI scan showed cervical kyphosis (forward bend in the neck) and stenosis. An EMG/NCV revealed some carpal tunnel syndrome and a cervical myelogram and contrast CAT scan re-confirmed the cervical stenosis and kyphosis.

Decision
This patient was an early stage of spinal cord injury with progressive symptoms in both arms and reproduction of the symptoms with neck motion. Her arm numbness wa beyond the territory for entrapment of the median nerve at the wrist.

Surgical Treatment
An anterior cervical corpectomy allowed decompression of the spinal canal. The placement of a strut graft corrected the kyhposis and provided spinal stability. Cervical plating protects the strut graft until fusion can occur.

Surgeon's Comment
This patient had a differential diagnosis between early onset cord compression and entrapment of the median nerve at the wrist. The rapid progression of her symptoms in the arms and the significant aggravation of her arm symptoms by lookin up made the case for intervention. Hard neurological findings in cervical myelopathy depend on the clinical grade of myelopathy (severity) and the duration of symptoms.The anterior decompression and fusion improved her symptoms.