Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

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Cervical myelopathy (CM) is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes.On T2-weighted magnetic resonance imaging (MRI), CM appears as a hyperintense area near the spondylotic spine.This high intensity signal depends on the impact of outer forces and their duration.It also determines the prognosis of the surgical candidate.

A 40-year-old male patient admitted to our clinic with right upper extremity weakness and Loaf Pans hypoesthesia that had started 2 months earlier.On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome.Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive.After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor.

Total resection of the herniated cervical disc fragment and the Fan Shop - NHL - Novelty mass lesion was managed.Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response.Final diagnosis was CM under effect of cervical disc herniation.Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes.

However, the principal treatment approach totally differs depending on pathology.When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed.The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery.Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery.