800 - From Pop to Pain: Navigating the Cervical Spine's Unexpected Symphonies

Case Diagnosis: Cervical osteodiscitis with epidural abscess leading to cord compression

Case Description: 60 year old female with past medical history of diabetes presented with chief complaint of neck pain that radiates to bilateral upper extremities associated with weakness, numbness & tingling. Pain started during recent hospital admission for DKA, after a reported pop in the neck during a bed transfer. As per chart review, patient was admitted for UTI related sepsis with DKA. She describes the pain as sharp with VAS 7/10 worsening any neck motion. On examination, there was severely restricted cervical range of motion with tenderness to palpation to cervicothoracic paraspinals, levator scapula and upper trapezius muscles. Spurling test was positive bilaterally. Manual muscle testing demonstrated 4-/5 elbow extensors and finger abductors, rest bilateral upper extremeties were 5/5. Furthermore, Hoffmans test was negative with symmetrical reflexes bilaterally.

Discussions: Cervical spine x-ray showed to what appeared to be around 50 percent retrolisthesis causing severe spinal stenosis. Case discussed with spine surgeons, and patient was sent for an urgent MRI. Results showed discitis-osteomyelitis at C6-C7 with epidural component resulting in moderate to severe spinal canal stenosis and flattening of the ventral cord. Patient was admitted to hospital for IV antibiotics and preoperative clearance for anterior C6-C7 corpectomy and C5-T1 fusion with posterior C6-C7 Laminectomy with C5-T1 fusion. Patient regained strength in bilateral upper extremeties.

Conclusions: In light of the diverse diagnostic possibilities associated with cervical neck pain, it is imperative to approach each case with heightened clinical suspicion. The presence of red flags are indicators of potentially serious underlying conditions. In this case, patient was elderly with recent infection and pain out of proportion associated with significant findings on X-ray. Timely recognition and appropriate management can significantly impact patient outcomes including same-day advanced imaging and urgent decompression surgery or treatments.