Progressive Cervical and Lumbar Radiculopathy with Neurological Deterioration

Case at a Glance

A 46-year-old female with a 16-year history of chronic back pain and previous L5-S1 laminectomy presents with progressive bilateral upper extremity weakness, cervical myelopathy symptoms, and new-onset lower extremity neurological deficits including foot drop and balance disturbances.

Patient's Story

The patient has suffered from chronic back pain for 16 years, with a surgical history significant for L5-S1 laminectomy performed 15 years ago. She is currently managed with Meloxicam 15mg daily. Over the past few weeks, she has experienced significant neurological deterioration. Cervically, she reports progressive bilateral hand weakness and forearm/bicep fatigue, with the right side more severely affected. She describes severe neck muscle tension and pain that improves with cervical support. Sleep is disrupted, requiring modified positioning with minimal pillow support. In the lumbar region, she has developed new left foot weakness, balance problems when descending stairs, bilateral plantar tingling that persists even at rest, and occasional sharp shooting pains with movement. The patient notes postural changes with forward head posture that seems to exacerbate her symptoms. Previous conservative treatments including physical therapy, epidural injections, and trigger point injections have been unsuccessful. She also has a significant surgical history of total colectomy and proctectomy for ulcerative colitis four years ago.

Initial Assessment

Physical examination revealed bilateral upper extremity weakness with right-sided predominance, cervical muscle spasm, postural abnormalities with forward head posture, left foot dorsiflexion weakness, balance impairment, and bilateral plantar paresthesias. The patient demonstrated functional limitations in activities of daily living due to progressive neurological symptoms.

The Diagnostic Journey

Two-year-old MRI reports showed cervical canal and foraminal stenosis of moderate degree, though not classified as severe, with equivocal lumbar findings. Given the significant clinical deterioration and poor correlation between old imaging and current symptoms, updated cervical and lumbar MRI studies were ordered to reassess the degree of neural compression and guide treatment decisions.

Final Diagnosis

Progressive cervical and lumbar spinal stenosis with multilevel radiculopathy and possible cervical myelopathy, pending updated imaging confirmation. Differential diagnosis includes progression of degenerative disc disease with neural compression at multiple levels.

Treatment Plan

Immediate imaging with updated cervical and lumbar MRI to assess current degree of stenosis and neural compression. Neurosurgical consultation pending imaging results to determine surgical candidacy and prioritization of cervical versus lumbar intervention. Conservative management continuation with anti-inflammatory medication and physical therapy for postural correction. Consideration of surgical options will depend on imaging findings, with attention to previous abdominal surgical history and potential scar tissue complications for lumbar approaches.

Outcome and Follow-up

Patient scheduled for updated MRI imaging to guide further management. Neurosurgical evaluation pending to determine optimal treatment approach and timing of intervention. The consulting neurosurgeon noted that the previous imaging findings were not definitively correlated with current symptoms, emphasizing the need for updated studies. Discussion regarding anterior versus posterior surgical approaches for lumbar intervention considering previous abdominal surgery and scar tissue formation.