# Degenerative Cervical Myelopathy in a Patient With a Pre-existing Cervical Spinal Cord Stimulator: A Case Report

## TL;DR

A patient with a cervical spinal cord stimulator developed degenerative cervical myelopathy, requiring alternative imaging and surgery for recovery.

## Contribution

This case report highlights the diagnostic challenges and management of DCM in patients with pre-existing cervical neuromodulation devices.

## Key findings

- CT myelogram identified cervical stenosis and cord compression in a patient with an SCS.
- ACDF surgery led to immediate motor function improvement and full lower extremity strength recovery.
- Alternative imaging was crucial for diagnosis due to MRI contraindications from the implanted SCS.

## Abstract

Degenerative cervical myelopathy (DCM) is a progressive condition that can lead to significant neurologic disability if not promptly diagnosed and treated. The presence of a neuromodulation device in the spinal canal, such as a spinal cord stimulator (SCS), can potentially hinder the diagnosis and management of DCM. Here, we report a case of a 53-year-old female patient with a history of complex regional pain syndrome being managed with a cervical SCS, who presented with DCM and rapid neurological deterioration and bilateral lower extremity paralysis. The diagnostic workup was rendered more challenging due to contraindications for MRI related to the implanted SCS. CT myelogram demonstrated multilevel cervical stenosis with cord compression; the cervical leads were believed to contribute to the central stenosis. The patient underwent anterior cervical discectomy and fusion (ACDF) from C4 to C7, resulting in immediate improvement in her motor function and an uncomplicated postoperative course. At discharge, she had regained full strength in the lower extremities. This case highlights the unique diagnostic and management challenges of DCM in patients with pre-existing cervical neuromodulation devices. A high index of suspicion and timely use of alternative imaging modalities were essential for achieving favorable outcomes in this complex patient. Further research is needed to establish evidence-based recommendations for the management of DCM in the setting of neuromodulation devices.