Cervical Spondylotic Myelopathy Presenting as Peripheral Nerve Disease: A Case Report

Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in the elderly population. It is a degenerative disease that classically presents with fine motor dysfunction of the hands and gait instability. These symptoms can easily be masked by old age, complex medical history, and more benign diseases. We describe the case of a 67-year-old male who was referred to orthopedic surgery for bilateral hand numbness and weakness attributed to carpal tunnel syndrome (CTS). The patient had trouble ambulating, rhythmic clonus in his ankles, and a bilateral positive Hoffman sign resulting in a referral to neurosurgery for an emergent spinal cord decompression. To our knowledge, few case reports exist demonstrating how cervical myelopathy can mimic more benign peripheral nerve diseases such as CTS. We describe how difficult early recognition can be, as well as the importance of primary care doctors maintaining a high degree of suspicion for a disease that has nonspecific examination findings and can easily mimic more benign processes.